Scott Palmer, CEO of Clariti Health, has dedicated his career to health IT in the ASC space, including founding and leading several companies over a 35 year career with products that continue to serve thousands of ASCs.
Two years ago, he embarked on efforts to examine the biggest pain points for ASCs and how technology could ease the burden; one of the recurrent themes from independent facilities, consultants and ASC management companies was patient responsibility.
Based on his conversations with ASC owners and operators, here are Mr. Palmer’s five key trends on patient estimation, pricing transparency, and technology:
1. Increased revenue cycle complexity. The amount of money Americans spend on healthcare has increased over the past several years and high deductible health plans are becoming more prevalent. Many Americans have $1,000-plus deductibles and families average $3,000 in out-of-pocket for healthcare expenses per year. ASCs are also seeing an increase in complex payer arrangements that impact self-funded plans, fully insured plans and other shared savings arrangements.
“We saw facilities across the country have complex payer arrangements; they were nonconforming in many ways and facilities need to manage them,” says Mr. Palmer. “The technology to organize payer arrangements wasn’t there. Many centers were still managing the data on excel spreadsheets or even paper.”
Around 82 percent of large employers are self-funded, and self-funded employer plans are managed by large insurance companies such as UnitedHealth, Cigna and Aetna. Within the plans there are now tiers which encourage patients to seek network providers at each level; patients on certain levels may not have their procedures covered at the center. Clariti mines eligibility benefit data to identify self-funded plans and tracks employers so facilities can identify employers, group numbers and other information which may impact patient cost share and coverage rules.
2. Growing demand for price transparency. Patients are paying a higher percentage of their healthcare bill today than in the past, which means they’re more aware of what they owe. Select states mandate price transparency, requiring facilities to give patients upfront price estimates to the best of their abilities; providers that don’t comply face penalties.
Some states also have laws to protect patients from unexpected bills. In essence, the laws often require providers to disclose out-of-network status to patients before delivering care. Facilities that don’t disclose OON status must then accept in-network rates.
However, the overall focus on transparent pricing could be a boon for centers. “Consumerism is good for the ASC industry,” says Mr. Palmer. “We are the low cost, high quality provider, so we should be promoting that. Clariti helps facilities provide personalized and accurate quotes for patients comparing pricing, in some cases while the patient is in the surgeon’s office.”
3. Patients require payment alternatives. Despite efforts to comparison shop for healthcare services, many patients aren’t prepared to pay the hundreds or thousands of dollars upfront for surgical care.
“In order to maintain that case, we need to present the patient with payment alternatives,” says Mr. Palmer. “The earlier you do that the better. You can offer convenience by accepting checks or allowing them to pay online. When that’s not an option, you can offer patients payment plans or connect them with a third party funding source. This is an evolving area and facilities will soon have new options available for their patients, including patients with lower credit scores.”
4. Upfront patient collections must be the norm. Patient revenue is approaching 25 percent at some ASCs, up significantly from 5 to 10 percent years ago. Back then, ASCs weren’t as worried about collecting the patient responsibility, but in the new environment that’s a requirement to financial success. “Collecting from patients after surgery is expensive and often you’re only able to collect a fraction of the bill,” says Mr. Palmer. However understanding patient financial responsibility in advance and reaching and presenting that to the patient is time consuming and in many instances facilities lack the resources. “We see business offices spending a lot of time trying to calculate an estimate, mailing or calling the patient and then having a difficult discussion regarding what they owe. We want to change that process.”
Clariti’s goal is to automate patient responsibility conversations so ASCs can electronically communicate patient cost share and payment options to the patient, allowing the business office staff to become counselors while maintaining the personal touch that ASCs are known for.
5. Outcomes will become increasingly important to track and report in value-based care. Healthcare organizations are increasingly responsible for proving patient outcomes. Clariti built in a function to collect patient reported outcomes surveys so healthcare providers and payers can identify the value of their care.
“We wanted to marry the upfront financial information with the back end quality information,” says Mr. Palmer. “It’s logical to me that patient reported outcomes are where we’ll spend our time in the future instead of experience surveys. Technology is able to make that an affordable and intrinsic part of gathering feedback to help clinical decision-making and provide the basis for continuing the ASC industry’s history of excellence.”
In addition to being a useful tool for clinical decision-making, patient-reported outcomes data can help ASCs and their surgeons during contract negotiations with payers.
Photo courtesy of: Medical Coding News
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