By Nitin Thakor, President & CEO
I read with interest this week an article In Modern Healthcare’s e-newsletter titled, “Uninsured rate dips below 10%.” The statistic comes from The Centers for Disease Control and Prevention.
In my opinion the most important sentence in the article follows: “The survey also found that 36% of people younger than 65 were enrolled in a high-deductible health plan in the beginning of 2015.”
The growing number of people – not only the young -- who are opting into these high deductible plans is forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcing healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.
Most hospital CFOs and group practice managers have no choice but to look for the next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased high self-pay volumes have driven many marginally performing healthcare organizations to the brink.
Other changes such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions, as well as the increased self-pay collection costs will all contribute to overall declining margins.
Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a Kaiser Health News report, out-of-pocket payment amounts under the Affordable Care Act (ACA) will range from $6,350 for individuals to $12,700 for families.
This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.