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R. Lewis Dark: Pathologists: Will CDHP-insured Patients Pay You?
FOR THOSE AMONG YOU WHO THINK STRATEGICALLY, our White Paper is
sure to be a revelation. It is a sophisticated and detailed overview of the
role Consumer-Directed Health Plans (CDHPs) will play in the upcoming
revolution within the American healthcare system.
Today I'd like to address one specific element in this White Paper. It
is the discussion, on pages 18-27, of new pricing pressures on hospitals,
changes to the revenue cycle, and how difficult it will be to collect large
deductibles from patients in CDHPs.
For anatomic pathologists, in particular, I'd like to call your attention
to a key point that emerges from this discussion. Laboratories and pathology
group practices will need to collect for services directly from
patients enrolled in CDHPs. Typically, these plans require patients to pay
a yearly deductible of between $1,000 and $2,500 as individuals (and up
to $5,000 for family deductibles) before insurance coverage will begin to
pay claims.
This means that laboratories and pathology groups must be prepared
to collect significant sums of money directly from the patient. Since most
clinical laboratories see a large portion of their patients (when specimens
are collected, for example), they have an opportunity to collect money
and discuss repayment with those patients. But anatomic pathology
groups, particularly those based in community hospitals, face a difficult
challenge. They will need to collect the full amount of the service directly
from CDHP-insured patients. But, through the patient's course of
treatment, that patient is likely to have never come in contact with any
pathologist or other employee of the group.
In my view, pathology group practices will be vulnerable to financial loss
as more patients are enrolled in CDHPs. That's because the billing and collections
departments of most pathology groups are organized with the expectation
that the primary source of claims settlements will be insurance companies.
Because CDHPs are expected to wreak major changes on healthcare's
traditional revenue cycle, I recommend that lab directors and pathologists
begin to develop business strategies that anticipate this problem. They
should create effective ways to communicate with CDHP-insured patients
that encourage timely and full payment of laboratory bills.
Helping Labs Get Ahead Of the CDHP Tsunami
Timely insights to help craft effective strategies
to benefit from healthcare's emerging big trend
Newsmaker Interview: Paul Mango
Consumer-Directed Health Plans To Be Healthcare's Next Wave
New plans give consumers
financial incentives to become
savvy buyers of their healthcare
CEO SUMMARY: It is widely known that growing numbers of employers
are turning to consumer-directed health plans (CDHPs) as a way to control
increases in their annual health benefit costs. But that is only part of
the story. CDHPs represent a major transformational force—one that
promises to push deep and radical change into the American healthcare
system. To give laboratory executives and pathologists a comprehensive
understanding of this important trend, THE DARK REPORT is proud to present
this detailed and candid interview with Paul Mango, a consultant with
McKinsey & Co. The substance of this information was presented by
Mango at the Executive Laboratory Forum in Tucson, Arizona last
September. At the invitation of Sysmex Corporation, a hand-picked group
of laboratory executives and pathologists participated in a two-day strategic
retreat, of which Mango was one of two facilitators.This interview was
conducted by Robert L. Michel, Editor-In-Chief of THE DARK REPORT.
Consumer-Directed Health Plans To Be Healthcare's Next Wave (Topics Below)
Changing Consumer Behavior
Managed Care Problems of the 1990s
Economic Basis of CDHPs
Explaining HSAs, HRAs, FSAs
Changes Soon to Confront Hospitals
Hospitals Face Effective Competitors
CDHPs Change Hospital Bad Debt
Why CDHPs Are a Threat to Payers
"Balance After Insurance" Problem
Financial Firms to Pursue HSAs
Four"Must Do's" to Win with CDHPs
Changes in Labs' Revenue Cycle
EPTs—Episode Treatment Groups
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