Physicians who practiced in the era of classical indemnity insurance still recall the old days of billing patients directly and then providing them with the means to submit their office visit bill to the insurer for reimbursement. It was a clear system — patients understood what they were getting for their healthcare dollar.
Managed care and HMOs changed all that by converting traditional insurance into first-dollar coverage and introducing low out-of-pocket plans.
But as healthcare costs rose, copays and deductibles grew. More recently, Health Savings Accounts entered the marketplace with dramatically lower premiums, but again, with large deductibles and copays. As a result, physicians are once again charged with collecting money from patients.
Now there is yet another model — the Affordable Care Act. Despite the perception of many, the healthcare reform law is not really about "free care" but rather "sharing" costs with the individual in a variety of ways.
Unfortunately, a lot of patients don’t understand the law and aren’t yet aware of the potential out-of-pocket costs. Most will come to the doctor’s office with their brand new insurance cards and pent up medical needs, not knowing that the cost of the first wave of services is coming directly from their own pockets.
Who is going to collect those fees? Once again, the answer is: your office. Those practices that have the systems to assess patient responsibility may reluctantly pursue payment at the time of the visit. For those who don’t have such systems, good luck chasing patients for money.
You see, the new norm is really the old norm: Patients paying out of pocket and physicians forced to play bill collectors, with reimbursement often being more trouble to chase down than it is worth.
Clearly the reform law will benefit millions of patients, providing them with access to care they did not have in the past and I do agree that is a good thing. What’s more, early results from California appear to support proponent claims that costs are going to decrease. The state’s first competitively bid rates were, in fact, below current rates.
Therefore, some try to allay physicians’ concerns by telling them not to worry; costs for patients will be lower. However, some continue to wonder how insurers could possibly increase benefits mandated by the Affordable Care Act while lowering rates. The answer to this question lies, in part, hidden in the interplay between the amount of government cost subsidies, the plan copays and the deductibles.
Costs may be lower for some — at least initially — but at some point patients could once again be paying more out of pocket, and physicians will — once again — be forced to collect payments.
There are many places to debate the pros and cons of healthcare reform. The question to address today is: What can physicians do about this ongoing role of asking patients for payment?
I think one answer is concierge medicine. Concierge care is also a payment to a doctor directly from the patient, but it is a very different sort of fee. It is a prepayment for a non-covered service, and one that is often handled by a company that makes the operational challenges of collecting and managing the fees much simpler for physicians.
For anyone who does not believe that their patients will pay for a medical service directly, they are not seeing the changes that are happening in the marketplace today. Concierge medicine has seen significant growth over the last few years, despite the out-of-pocket fees. Because patients do value their relationship with their physicians, I think we’ll only continue to see growth and interest in the coming years.
Physicians will continue to need to ask for payments. The question is: Will those payments be for fees patients question and don’t understand? Or will they be for services that provide real value to patients who choose to receive and pay for a higher level of care?
What are your thoughts on the Affordable Care Act and the fees physicians will be asked to collect? Have you started thinking about how you’ll collect fees? Would you feel better if you were providing a valued service — e.g., more services and care from you — in exchange?