Even this late in the year — when we typically assume many patients will have met their deductibles — we are hearing from practices that some patients seem to be delaying or avoiding care because of concerns about costs.  This is not limited to the ACA plans, which tend to have high deductibles, especially on the ‘bronze’ end.  Even patients with corporate plans are now facing enough out-of-pocket responsibility that it affects their decision-making. Some patients who may have had a trivial deductible in past years now have one with real teeth– one that is less likely to be fulfilled unless a major illness or injury happens during the year.  As a result, some practices aren’t seeing the expected influx of patients who want to get needed care before the end of the year — and some physicians and practice managers are concerned about the well-being of both their patients and their practices as a result.

Patient caution and awareness of cost may be a good thing in some cases (if it helps patients become more judicious about using optional services, and or encourages more engagement with providers and health plans).  That’s certainly one of the goals of high deductibles.  But the problem is, in some cases high deductibles might also discourage patients from getting care that they really need.  And, of course, it certainly doesn’t help your practice to establish and maintain a relationship with patients when they’re afraid to come in for a visit(!).

It can be frustrating to know how to respond, since physicians and practice managers can’t do anything to change the terms of the health plans their patients are on.  What’s more, if you’ve been watching this blog, you already know that it’s very important to stay within the lines of your payer contracts (e.g., selective discounting or waiving of co-insurance is likely verboten).

There are a few things you can do, though — and it’s a good idea to take a look at some of these things now, because the deductible reset (January 1) is right around the corner.

Preventive care:  If you are a primary care practice — including peds and OB/GYN — make sure your patients understand that some services (including preventive care visits) come with no patient financial responsibility. And make sure you are recalling patients for their annual visits!  This communicates that you care about patient well-being, allows you to stay in touch with patients, gives the patient all the health benefit of preventive screenings, and also helps your practice business by providing a smoother stream of revenue that costs less to collect.  And if you are a specialty that offers no-out-of-pocket preventive screenings like mammograms or colonoscopies, work with your primary care referral partners to let patients know that.

Follow up visits: Some patients are so nervous about costs that they skip scheduled follow-up appointments — even though follow-up for surgeries, maternity and other costly services is typically included in the global payment.  Make sure staff know which follow-up appointments carry no costs, and make sure they remind patients of this (and that their follow-up care is important) at the time of booking.  This is another excellent opportunity to communicate how much your practice cares about your patients.

Clear pricing: Patient fears about paying out-of-pocket are exacerbated by lack of transparency — especially since high shock-value stories of skyrocketing medical costs are released by the media practically daily.  Patients may well assume that the cash cost of a visit or service is much higher than it actually is.  Make sure your cash fee schedule is up-to-date, and make sure patients know that a short visit is not likely to bankrupt them.

Hardship adjustments: Some patients may truly be unable to pay the total amount of their responsibility, especially for more expensive/extensive services with significant co-insurance.  Simply discounting or writing down the patient portion might not comply with your payer contract — payers usually want any discount you apply to the patient portion to apply to theirs as well.  But your payer may have terms that permit some adjustment in the case of demonstrable hardship.  Be sure you understand those hardship rules — review your contract, check the payer portal, and call the payer if necessary for clarification — so that you can offer legitimate assistance to patients who qualify for it.

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