Self-Pay is New Way: In Imaging Economics

As seen in the January/February Issue of Imaging Economics 

                   

The Last Word: A Take on the Radiology Community
Self-Pay Is New Way
by Chris Christenberry
                                 
Patient responsibility is becoming a major player, even MVP, in health care.

As reported in the Wall Street Journal and the New York Times, the Kaiser Family Foundation Health Research Survey reported that health care insurance premiums paid by employers rose by 8% in 2011. The “WOW” factor is increasingly more powerful when paralleled by the fact that premiums should have slowed as more employers elected to offer high deductible plans. The rapid growth of both employer premiums and high deductible plans foreshadows the upcoming trend for health care providers, that patient responsibility will become a major player, even MVP, in health care discourse.

I have the unfortunate dilemma of balancing health care dollars. On one hand, my facilities and the health care clients we serve face continuous reimbursement cuts. On the other hand, our company and employees are paying more each year for our own health care. And yes, our premiums rose by 8% last year as well. Over the past 5 years, we have seen close to 25% decreases in payments. Imagine the impact a quarter of your paycheck disappearing would have on you. Now imagine your expenses increasing the same amount, too. It’s a truly unfortunate dilemma, so what is the key to combating this situation?

With the unique vantage point I hold for both sides of the provider-patient relationship, I understand the challenges the nation faces in dealing with limited health care dollars. You have heard it before, “the US system is broken.” Indeed it would seem so, as one side of the political spectrum screams for our government to pay for health care it obviously cannot afford while the other side of the spectrum demands that patients pay for their own care. So what happens when these patients must resort to this?

In a more perfect world, void of the challenges that our current system faces, companies and the government would be able to afford catastrophic health care policies. By catastrophic, I mean big-ticket health care events such as hospitalization, debilitating diseases treatment like cancer care, or end-life events. Large health care insurance companies could use the actuarial tools their cousins in the life insurance industry use. In other words, if it is true as the pundits say that “most of the health care costs occur the last year of one’s life,” then the health insurance companies could surely hedge for a catastrophic event in a patient’s life; however, doing so would still require the patient to take on some responsibility.

Patients would be required to pay for normal doctor visits, medication, and diagnostic testing; however, these patients, or their companies, could be awarded reduced premiums by maintaining healthier lifestyles and receiving wellness check-ups, in much the same way that good drivers are awarded lower costs in the auto industry. Patients paying for this level of health care would create a market where they are more cognizant of their health dollar. In the near future, we’ll see tools designed to help patients understand the true costs of their health care, thus enabling them to negotiate what they pay out of pocket.

Hogwash, one might say to the notion of patients actually paying for their own health care. In reality, self-payors are growing increasingly more popular as health care players. With 17% of employees in high deductible plans, these plans have grown 25% in the last year. The average family of four already pays close to $3,500 out of their pocket for their care, and you can ask any physician group and they will tell you that the self-pay component is growing. Allow me to suggest that providers, insurance companies, and patients accept this new reality, because in the same way that paper phone books, Blockbuster, and disposable cameras have become obsolete, so will the notion that patients will be protected by their insurance, so as not to have to pay for a large portion of their health bill. Yes, patient responsibility for payment can seem daunting, like picking up the tab for an expensive dinner you know you cannot afford, but forward thinking is the key. Self-pay is the new player, and price shopping is the winning game plan.

Chris Christenberry is CEO of Atlantic Health Solutions based in Tampa, Fla.

Start shopping for your own health care at Save On Medical

                      

Accountable Care Organizations (ACOs) Explained

The Issue

Currently th U.S. is responsible for consuming 55% of the world’s healthcare dollars. Around 45% of that is being spent in hospitals and 25% is going directly to the physicians. If we continue this way and do not change our processes, by 2017 we will be responsible for 75% of the world’s healthcare spending. Excuse us, but we’re going to agree that we are in dire need of some serious health care reform. The government has proposed a number of healthcare changes that would work to achieve the goal of lowering spending to get the U.S. out of debt, but what is the most talked about resolution? Accountable Care Organizations.

So, what is an ACO really?

- A joint venture of providers that network to share responsibility of providing care to patients

- Combined: Leadership, decision making and payment

- Promotes improved quality of care for Medicare patients and lowered costs

- Physicians are rewarded for maintaining wellness for patients, rather than for services rendered

More Details

“Care Core”

The core leader of an ACO is important because the level of success that leader has had in the past can be indicative of the venture’s overall success. One might think that the logical “Care Core” would be a large hospital, however most believe the “Care Core” should be Primary Care Physicians.  This advanced style of physician integration is easier for larger facilities, but does not aim to disclude smaller practices. The Senate even states that an ACO can be built and successful without hospitals altogether.

What Will ACOs Mean for Healthcare?

- Full integration into the industry for those providers involved

- Lowered healthcare costs, movinh away from fee-for-service model

- An aligned payment system for patients and providers

- Improved quality of care 

- Lessened concern for the commoditization of imaging facilities

- Decreased over-utilization

- Focus on patient wellness and prevention of illness

Proposed Legislation in Florida to Require Cash-Pay Price Listings

Physicians throughout Florida have commented negatively on this proposed legislation which would require their offices to post pricing in their offices.  Many are saying that the law would  not only be intrusive but also pointless for patients.  The need for pricing transparency in healthcare is evident however, and this could be a step in the right direction for patients, but it is not the cure-all answer. Our in-house legal council, Jeff Greenberg, comments on the proposed legislation:

Proposed legislation in Florida may require doctors and other providers  to post signs in their waiting rooms showing the prices to be charged a person paying with his or her own funds, i.e.,  without insurance. Charges for those with insurance depend on the applicable policy and would not have to be posted.  However, with the immense amount of uninsured Americans rising steadily and the prevalence of patients with the popular 80-20 plans, these cash-pay pricing structures will prove to be a necessity for much of the patient population.

This new legislation would require urgent care centers, surgery centers and imaging centers to show prices for their most common procedures. Additionally, two separate bills on the issue would require price sheets to be given to every patient. Voluntary disclosures have not worked, but most industry lobbyists do not appear to think these bills will help patients either, and may just end up adding costs to medical providers for the signs.

It seems that while conceptually the bills are aimed at helping patients make their decisions, it is still unclear whether or not it will really change much for them, unless they call in advance for the pricing. If the patient arrives at the office and sees the pricing, would they be willing to walk away because of the prices without knowing what other comparative facilities might charge for the same service? The pricing transparency is much needed, however the efforts will not be beneficial to patients without the ability to compare. Also, the prices listed may still not actually be ones that patients would ultimately pay, as they could just be part of a standard “fee schedule” which may not be reflective of an actual cash-pay price that would be acceptable to a provider. Cash-pay patients are able to negotiate better rates for services though through online scheduling services like Save On Medical or by direct communication with the provider.

Whether the legislation will become law is unknown at this time, but whether it does or not, the level of impact it will have will be null without further efforts of patients and providers alike.

Jeffrey Greenberg

Greenberg Hirshfeld PL

Atlantic Health Management Solutions, LLC

Physician Integration: The Key to Successful Healthcare Marketing

We’ve been talking a lot about new trends in healthcare marketing like social media efforts and community outreach, but the most important component in marketing your practice is what we like to call “physician integration.”  USA Today discussed last week the new way hospitals have started to implement this.  They call it the physician-to-physician sales approach.  Tenet Healthcare, one of the largest for-profit hospital chains, has adopted this by hiring sales representatives to serve as face-to-face marketers to improve their hospitals’ referral rates.  There are many supporters and critics of this process, however it is evident that there is value to the process.  Success however, lies in the intrinsic goal of these individuals and the way the marketing is put in place. Our marketing representatives have been doing this for independent practices for years, serving as physician’s liaisons and extensions of the referring practices.

                 

Most hospitals have hired on former drug reps due to their experience in the medical field, this is sometimes counterproductive because they can have tunnel-vision on one specialty and can come off too “salesy”.  The key to successful physician integration is providing added value to referring physicians and serving as an outlet and also source for success.  In the same ways that large practices are leaning on ACO’s for shared success, physician outreach aims to help connect physicians in a mutually beneficial way.  Often times specialists love this concept because they have a lot to gain from general practitioners, however that family practice physician rarely sees the benefits of that relationship.  Our mission is to find routes for referrals for every niche in healthcare.

(Photo courtesy of Adrenaline)

The strategy for creating these ties requires three things:

1. Knowledgeable and personable marketing representatives with a sales-centric focus, without wasting the time of the physicians
2. Physicians seeing a need for the process
3. Then the adoption and involvement of the physicians

Hospital CEOs have seen the need for this type of marketing in their mission to find ways to increase patient referrals, without increasing unnecessary admissions, while also improving patient ratings.  This is essentially the same need that we see independent practices having, of course on a smaller scale it is much simpler to implement, as we can more easily understand the needs of physicians and patients at a more localized level.  Just as Michelle Osipowicz states in the USA Today article, it is important to listen to and address the concerns of referring physicians to successfully provide that value. 

By aiding these practices in their physician outreach programs, we help them to achieve improved community presence, serving as an influencer in the industry, which has a direct effect on the practice’s patient volume.  This type of practice-to-practice approach, when combined with social media excellence, community involvement and continued quality service results in ensured overall practice success.

What Independent Physicians Can Learn from Hospital Systems

Recent conversations in the healthcare world have suggested that practices either need to go big or go home in regards to their associations in the future.  The highly controversial trend towards ACOs and large practices or hospitals buying out smaller, independent practices suggests that those small groups had better join forces if they want to survive. This could not be farther from the truth, and there is something to be said about the preservation of the “independent physician.” The fact is that independence equates to sovereignty, whether you’re talking about states or practices.

In our experience with many talented and notable physicians over the years we have come to realize that doctors are by nature, autonomous.  Of course there are instances where this is untrue, but it seems to be a general concern, that physicians who have worked so hard to build their own, independent practice are not going to want to throw away their dedication to join a large system. Those big fish usually like their little sea. So we have dedicated time to find ways in aiding these providers to find success without giving away their independence.

                                          

From a patient perspective, there are pros and cons to both types of physicians but let’s focus on the important part of patient care. CARE. When something is wrong or you have been diagnosed with an unfortunate condition, do you want to be a number, or do you want to be Ms. Jane Doe with a name and a face to go with your medical chart.  As a patient, it is important to me to feel confident in my physician and there is something about an independent facility that make me feel more comfortable.

From the perspective of the independent practice, competing with larger scaled practices can be daunting. It is important for those facilities to play up their strengths and learn from the expansive marketing campaigns that have been successful for large hospitals like The Mayo Clinic. While the process based off of a grander scale, hospital-based practices and independent facilities do share the same intrinsic end goal and that is wellness, convenience and quality care for patients. A number of social media practices implemented by hospitals like The Mayo Clinic could easily be put into action at a smaller level, such as:

-       becoming a resource for medical information through social media by encouraging your doctors to get involved

-       sharing knowledge through blogging, ex: testimonials, success stories and things healthcare professionals have learned through their experience in the field

-       using real-time communication and updates through Twitter, some hospitals have done this in correlation with The American Red Cross or with the participation of families with a relative in surgery for live updates

-       Fundraising for events or local charities

-       Communicating with current, previous and potential patients from a customer service aspect

-       Connecting patient or patient family followers to helpful community resources and deals. Ex: Sending out a coupon for a local floral shop

-       Patient highlights and involvement to promote an encouraging environment

There are many ways to implement these processes, but the fact is that no matter if your practice is located in Downtown Manhattan or in Norfolk, Nebraska, these social media campaigns can be personalized and successful.

If these social media marketing initiatives are used correctly, a practice of any size can gain leverage in the industry. Author Richard Reece points out that a practice’s capacity for success is dependent upon the way leverage is managed however.  He comments saying, “Leverage is a fragile, malleable thing. It depends on public trust.”  In order to balance your practice’s leverage, no matter the size, one must focus on; management, chains of command, administrative abilities and the implementation of leadership practice values.