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Patient deductibles have gone from getting patients' "skin in the game" to being "skinned alive." Their problems are physicians' problems.
Obamacare's cost-control plan to give patients "skin in the game" through higher deductibles has been shanghaied to control premiums within legal limits, transmuting "skin in the game" to patients being "skinned alive."
With the minority of patients with high-deductible health plans quickly becoming the majority, practice strategies must adapt, or find themselves flat-footed with a rapidly bloating accounts receivable.
The argument that Health Savings Accounts and Medical Savings Accounts pick up the slack is a bad one. They are, with very few exceptions, underfunded and inadequate, causing patients to react in one of three ways:
1. They simply forego care when the funds run out and / or budgets are stretched, and practices demand payment at point of service.
2. They have every intention of paying when payment is not demanded at point of service, and, often don't, mostly out of anger with their insurer and out of sticker shock.
3. They get creative, looking for bargains since everything except major medical is out of pocket.
The latter is gaining popularity because it is the most practical solution, and, that means the driving motivation for price transparency is not going to be bureaucrats' and policy wonks' dithering, but instead building consumer demand.
Consumer demand has its own dynamics and rules. You can't control it, but you can manage it and, if you are astute, even turn it to your advantage.
With fee-for-service reimbursements beginning to go from payer-driven to consumer-driven (meaning it makes more sense for the patient to just pay an agreed price out of pocket and let you bill the plan to charge against deductible), you have three choices - a lot like restaurant strategies:
1. Fine Dining Strategy: No prices or limited choice a la carte pricing, providing high quality, limited access. If the patient can't afford it, they shouldn't be there. Patients are accepted into the practice.
2. Casual Dining Strategy: Simple, competitive prices on a stay-in-store menu categorized logically combined with good service, quality care, and a consistently good experience. Specials advertised occasionally, but, mostly communicated by word of mouth. Patients are welcomed into the practice - so long as they can pay at the point of service.
3. Fast Food Strategy: Good value, prompt service, high volume, and prices posted on the wall. Nothing complicated. Pharmacies, Wal-Mart and others have this one cornered. Everyone's welcome: cash, credit, insurance, whatever.
The rest is simple.
What strategy works for your practice? Just a suggestion, but restaurants use marketing professionals to get things just right: the right approach, presentation, and tone. It may be a good investment for your practice as well.