Law describes the pertinent industry patient transitions this way: “We’ve transitioned this business, which used to be a physician-to-carrier relationship, into a physician-to-patient or -consumer relationship.”6 He cites the necessity of developing clear images and metrics of patient and payer personas using various propensity-to-pay and propensity-for-friction metrics as critical today in successfully collecting physician revenue.
Explore This IssueACEP Now: Vol 35 – No 09 – September 2016
At a true nuts-and-bolts level, this involves careful scrutiny of patient information to understand patients’ tendencies and proclivities to pay for your services. It culminates in the development of patient protocols and best practices for patient contact and engagement. Butcher additionally describes linking clinical diagnostic data elements to define patient groupings to develop more refined and better care delivery as we migrate toward population health care models.7
Why Is This Important?
Patient financial responsibility for medical care continues to rise. The Kaiser Family Foundation reported in 2015 that “since 2010, deductibles for all workers have risen almost three times as fast as premiums and about seven times as fast as wages and inflation.”8 Additionally, the just-released Milliman Medical Index report notes that “the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $25,826.”9
It will be an ongoing challenge to anticipate the dynamics of the continually evolving emergency patient who must first receive quality care, resulting in high experience-of-care scores. Additionally, your business partner must be technically skilled to uncover the metrics that will predict and result in the best financial outcomes for your practice.
The payer industry continues to move toward value-based payment models, and EM continues to face increasing reimbursement challenges and pressures. It has become more important than ever that your patient collection protocols be sharply defined using the best available metrics to legitimately collect the revenue you deserve.
MR. HOLSTEIN is director of development at Zotec Partners.
- Melville N. ‘Difficult’ patients more likely to be medically misdiagnosed. Medscape. March 16, 2016.
- Wang DE, Tsugawa Y, Figueroa JF, et al. Association between the Centers for Medicare and Medicaid Services hospital star rating and patient outcomes. JAMA Intern Med. 2016;176(6):848-850.
- Kutscher B. Paying patients for saving money. Mod Healthc. 2016;46(15):11.
- Gooch K. Study: Satisfied patients more likely to pay medical bills in full. Becker’s Hospital Review. March 16, 2016.
- Dussault N, Pinkovskiy M, Zafar B. Is health insurance good for your financial health? Liberty Street Economics. June 6, 2016.
- Law S. How your health system’s physician group data can leverage your hospital’s success. Becker’s Hospital Review. March 29, 2016.
- Butcher L. Consumer segmentation just hit healthcare. Here’s how it works. Hospitals and Health Networks. March 8, 2016.
- Employer family health premiums rise 4 percent to $17,545 in 2015, extending a decade-long trend of relatively moderate increases. Kaiser Family Foundation. September 22, 2015.
- 2016 Milliman Medical Index. Milliman website. Available at: http://www.milliman.com/mmi/. Accessed June 15, 2016.
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September 25, 2016Myles Riner, MD
John, as I have said before, these kinds of calculations don’t take into account the possibility that newly insured Medicaid patients may use the ED more frequently than these enrollees did prior to having insurance coverage. The data is still a bit conflicting on this
but it is likely to be driven by local conditions, such as the availability of primary care services for these new Medicaid enrollees. It is likely that in many areas where Medicaid expansion ensues, EDs and ED physician groups will find themselves having to staff up (and thus increase their overhead) to meet this demand, and since Medicaid almost always fails to cover the costs of providing these ED and emergency physician services: the net effect of Medicaid expansion for certain EDs may actually be a reduction in net revenues, rather than a gain. Arguments to the contrary just feed into the notion that the solution to ensuring the financial wellbeing of the emergency care safety net is to expand Medicaid. This may help some EDs and EP groups, or it may sink them, depending on circumstances often beyond their control (unless it forces them to skate around the thin ice of EMTALA violations by aggressively ‘deferring’ ED care of Medicaid patients).