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95 Coding, Billing & Collections ASC Success in the Age of Consumer Responsibility: 3 Thoughts on High Deductible Patients By Carrie Pallardy F ollowing news of the hallmark acquisition of Humana by Aetna, many observers' first thought — and concern — is this kind of consolidation is a bad thing, as it will inevitably lead to less competition and higher prices. However, some industry experts are anticipating the opposite. While the fear that consolidation will reduce competition is justified in many cases, this may not necessarily be true in the health insurance industry. In fact, consolidation between Aetna and Humana, as well as Cigna and An- them, which are also discussing a potential deal, would create an entity that would likely be able to win more favorable contract terms from medical pro- viders, according to CFO magazine. "Scale is becoming increasingly important when you look at the technology in- vestments needed to do more sophisticated data analysis to figure out how to help people be healthier," Jim Winkler, chief innovation officer at Aon Hewitt Health, told CFO magazine. "at requires capital. But scale will also give health plans better negotiating leverage. Providers obviously won't love that, but it will help the healthcare marketplace move faster toward payment for value instead of paying providers on a fee-for-service basis. And that's a good thing." Mr. Winkler acknowledges that it may be counterintuitive to think that con- solidation could have a positive effect on pricing. While he admits that a narrower choice of carriers could enable insurers to increase their fees for administering health plans, fees account for only 15 percent to 20 percent of overall health costs. e more significant portion of these costs is for claims, and "those costs are a function of the contracted rates negotiated between providers and insurance carriers," he said. It is consolidation among providers more so than insurers that employers and individual consumers should be worried about, as these can lead to increased cost, according to Mr. Winkler. For example, a hospital that acquires an inde- pendent physician practice essentially transforms it into an outpatient facility but charges higher prices for services and procedures than the stand-alone practice did. n F rom January 2013 to January 2014 the number of people enrolled in health savings accounts/high deductible health plans increased from 15.5 million to 17.4 mil- lion, according to an American Health Insur- ance Plans survey. HSA/HDHP enrollment has grown at an annual rate of 15 percent since 2011. As healthcare stakeholders continue seek ways to curb rising costs, the trend of high deductible plans will only gain steam. Many of the plans offered through the ACA exchanges qualify as high deductible and employers are increasingly shiing employees to plans with higher deduct- ibles and co-pays. ese plans shi financial responsibility away from payers to the patient, but this changes how providers are reimbursed for their services. is trend is changing ASCs' patient popula- tion. Patients are no longer passive recipients of care, but active consumers that are rapidly be- coming a payer group. Vickie Begy, vice presi- dent of managed care contracting with Surgical Management Professionals, shares three key points on serving high deductible patients and maintaining financial success in ASCs. 1. What more high deductible plans mean for ASCs. A surge of high deductible patients could drastically slow a center's revenue cycle. "Failure to have an effective process in place for collecting up front puts the ASC at risk to forfeit a portion of the negotiated allowable rate and reduce the profitability forecast during the bud- geting period," says Ms. Begy. Days in accounts receivable have the potential to rise, as ASC col- lections offices chase high deductible accounts. "e exchange plans also are a consideration. If the exchange premium is in delinquency status, the ASC may risk denial of claims due to retro- active termination of the patient's policy," says Ms. Begy. 2. What ASC leaders can do to limit fi- nancial impact. Upfront collections are be- coming a necessity. Patients want to know their financial obligation and collecting a set amount – if not the entire amount – up front will minimize the possibility of non- payment after the date of service. "Establish a solid upfront policy and procedure to finan- cially prep the patient prior to surgery. This includes thorough verification of benefits, medical policy review for the procedure to be performed and layering the negotiated rate with the insurance company," she says. Main- tain open channels of communication with patients. The less of a surprise the bill is, the more likely an ASC will be paid in full. 3. How ASCs can improve the experience for high deductible plan patients. While ASC lead- ers must establish strong processes in place to en- sure high deductible patients meet their responsi- bility, it is important to consider how this affects the patient experience. "A patient is referred for surgery due to a medical issue and this is a stress- ful situation," she says. "Lessen the stress by being transparent, mindful of the physical and emotion- al challenges the patient may be facing. Providing upfront expectations and options based on your ASCs established policy will be better received up front versus on the backend." Ms. Begy recommends evaluating staff mem- bers' ability to estimate cost and ask for pay- ment and involving interactive role-play in staff training. ere may be resistance from patients and staff members alike, but setting and main- taining expectations will lead to long-term suc- cess. "is [trend] is not going away and will remain the same or increase, so it is best prac- tice to establish a good working process now," says Ms. Begy. n Insurer Mega-Mergers Could Produce Counterintuitive Effect By Tamara Rosin