Provider, vendor, and patient—we are all suffering from the same thing: access to healthcare, or a lack thereof.
Although the number of people who are insured is increasing, high deductibles and premiums often force them to “bite the bullet,” so to speak, and do without necessary care, which in turn is affecting patient volumes. (Ungar and O’Donnell, 2016)
Throughout the United States, the number of people who are insured has been increasing since passage of the Affordable Care Act (ACA), but access to care has steadily decreased. From 2013 to 2014, those without health insurance coverage fell to just 10.4 percent (Schanzenbach, Dokko et. al, 2015), but it is not producing the intended effects.
According to physician Praveen Arla (Ungar and O’Donnell), those who were once uninsured are finally coming in to see the doctor, but the middle-class is starting to stay further and further away from the doctor’s office.
“[Patients with job based plans will say] ‘My deductible is so high. I’m trying to come to the doctor as little as possible. … What is the minimum I can get done?’ They’re really worried about cost,” Arla said.
Some alarming facts back up his anecdote.
For starters, use of hospital care among insured workers has been dropping since 2010. Use of outpatient care, which was previously unaffected, dropped for the first time from 2012 to 2013 (Ungar and O’Donnell).
Patient loads across the country have shifted. Where a provider would previously see as much as 45% of patients commercially insured and just 25% on Medicaid, those numbers are now reversed (Ungar and O’Donnell).
This has affected providers by greatly decreasing the volume of patients, and therefore, income to their facilities.
As a provider, what can you do to help combat this—to provide better healthcare to those who need it, and to simultaneously offset the pain of increasingly lower patient volumes?
- Switch up your pricing model, if you haven’t already. One particularly effective thing for many practices has been to adjust their pricing scale. Offering a discounted rate has traditionally been done for patients paying with cash, the uninsured, or underinsured. With today’s high premiums and even higher deductibles, having employer-provided insurance is often equivalent to having none—these prospective patients will be particularly grateful to you for working with them to find a lower-cost solution. This discounted rate is not what would be billed to the insurance company—it is whatever is affordable in the community to ensure access to care. When patients are paying for their own services out of pocket, they don’t necessarily need to go to an “in-network” provider. They can pick to whom they want to give their money. A provider who adapts to this increases earning potential, and many times, the instances of quick and full payment for services.
A former radiology director, Novarad’s Breda Drury shared her practice’s story of success with tiered payments in a saturated market.
“There were a lot of imaging centers near where I worked,” Drury said. “What we did to niche ourselves into the market was create a different payment structure for those with high deductibles, for those uninsured or underinsured, and we captured that market. They came in with checks, and that was it. We were done. A lot of times, they were our best payers.”
- Cling to big data. Much more than a buzzword, you will truly find an ally in big data when it comes to parsing your practice. Underperformance can kill a business, especially smaller ones, and big data shows where those areas are. Finding data for waiting times, understanding cost-benefit analyses, and projected ROI can give you the proof you need to ask for newer equipment, or provide you with the necessary proof as the decision maker. It can also help connect the dots to what kind of payment structure would be most effective for any given facility to implement. A practice management tool can identify where your revenue is coming from, which insurance providers are paying, and expected statement of cash flows.
- Use an executive dashboard service, like NovaDash. An executive dashboard program offers a “bigger picture” view of practices. It is indispensable in helping to monitor things such as key performance indicators (KPI) like patient volumes, modality productivity, and more, and can help answer questions like what days are best for services, how many patients are insured (and by whom), and can even offer suggestions as to what might help make a practice more lucrative. Even just being able to see your practice functioning at the enterprise level can bring to light better ways to operate and increase revenue. Novarad offers an executive dashboard service called NovaDash, which has proven very helpful in providing insights for providers.
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