In an Era of Healthcare Consumerism, Revenue Cycle Management Companies Help Hospitals Stay Afloat

For the foreseeable future, the Affordable Care Act or ACA is here to stay. With its continued implementation, the law continues to change the healthcare landscape as Americans know it.

More specifically, the landmark law has spurred a change in the way patients look at—and acquire—healthcare services. According to a 2016 report by InstaMed, healthcare providers saw a 74% increase in patient financial responsibility.

Data shows that during the 2016 open enrollment period, 90% of the 12.7 million people who got coverage from the health exchanges got a high-deductible plan. Compared to 2006 figures, this represents a 225% increase in out-of-pocket expenditures during hospital trips.

Healthcare Consumerism Necessitates Revenue Cycle Management Companies

Two Sides to the Equation 

This shift in consumer behavior suggests that people not only want to save money, but they also want to have more control over their healthcare expenditures as well. After all, if a person rarely gets sick, why should he pay a higher premium that he knows he can’t take full advantage? By choosing a high-deductible plan, he pays a lower monthly fee and just pays for whatever fees his insurance plan doesn’t cover.

However, this scenario also presents challenges for a hospital’s revenue cycle management. According to research, only 50% to 70% of a patient’s balance is ever paid off, with the remaining amount eventually turning into bad debt. The inability of patients to pay the full bill seriously affects a hospital’s cash flow—and its ability to continue providing excellent healthcare.

Change in Priorities 

Not surprisingly, hospital executives are reevaluating their priorities to address this new development in patient behavior. As revealed by a 2017 survey conducted by Advisory Board, 57% of the surveyed executives said that they want to focus on developing innovative approaches to help reduce the cost of healthcare. In an era of healthcare consumerism, where more people choose to get treatments from walk-in clinics, offering more affordable services will help attract more patients. The lower pricing also helps ensure that fewer patients will be unable to pay off their medical bills.

Another way that hospitals can innovate their processes is by hiring revenue cycle management companies that specialize in eligibility enrollment. After all, many of the people who can’t pay their hospital bills are eligible for programs such as Medicare and Medicaid. By subsuming their medical bills under these programs, hospitals have a greater chance of being fully reimbursed.

No one knows where the ACA will be in a few years, but one thing is for sure: in this consumerist healthcare landscape, innovation is key to keeping hospitals afloat. 

Hospital Execs Focus on Outpatient Growth, Healthcare Costs,
74% of Providers See Increased Patient Financial Responsibility,

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Categories: Revenue Cycle Management