Collecting Patient Fees Requires Delicate Touch Amid Soaring Health Care Costs

By Susan Kreimer
October 10, 2017

It’s a task a practice’s administrative staff must undertake to stay afloat. Price transparency and payment plans can help recoup money owed.

As consumers’ out-of-pocket health care expenses continue to soar, physician leaders must deal with some of the repercussions: how to collect payments for services without souring relationships.

Copayments are giving way not only to colossal deductibles in some cases, but also to hefty percentages of coinsurance. And while many physicians feel uncomfortable broaching finances directly with patients, it’s a task the administrative staff must undertake for a medical practice to stay afloat.

“Many of our patients have insurance, but they really aren’t insured because of the huge deductibles,” says Dennis Ramus, MD, a family physician and chairman of the board at The Physician Alliance, a group of more than 2,200 physicians in the Detroit, Michigan, area.

“It has become more challenging with higher deductibles for the past three to five years,” Ramus said, compared to when co-payments were the norm. “People have been used to spending 20 dollars for office visits.”

In the practice of Mott Blair, MD, FAAP, a family physician in Wallace, North Carolina, the concept of “no money, no mission” has become a necessary reality. For patients who are uninsured or have limited means, the practice offers a sliding-fee schedule and other fee-for-service discounts. If they still can’t bear the costs, he tells them about federally qualified health centers that receive government subsidies.

“It does cost a certain amount to deliver health care,” says Blair, who practices with two other physicians and one physician assistant. “You have to keep your doors open and pay your staff.”

In 2009, Blair became an employee of Vidant Health in nearby Greenville, a nonprofit hospital system that annually serves more than 1.4 million people in the state’s 29 eastern counties. Times have changed since 1990, when he joined father, the late James Seaborn Blair Jr., in practice.

“We never discharged anybody on the inability to pay,” he recalls. “We’ve been taking care of families forever.”

When it comes to specialty procedures for life-threatening conditions, there’s little time to spare in inquiring about payment options before initiating interventions, says Howard Walpole, MD, MBA, vice president of the Northeast Georgia Health System, and treasurer-elect of the American College of Cardiology.  

“Many cases of cardiology are emergent,” Walpole said. “In my practice, we try to keep physicians concentrated on the patients’ medical care and not on the financial situation.”

Transparency concerning a physician’s charges for less-urgent procedures is paramount. A proactive approach works much better than a retroactive one because patients are more resistant to bills they didn’t anticipate. Payment plans that allow patients to pay an affordable portion of their bill each month may help practices recoup the money owed without resorting to collections, physicians say.

Practices submitting unpaid bills to an outside agency would be wise to hire one with a forte in medical debt, says Irene Hoheusle, IFCCE, CCCO, vice president of collections and education at Account Recovery Specialists in Wichita, Kansas, and a member of ACA International, the Association of Credit and Collection Professionals.

“Medical debt is a different world, created out of necessity, not desire,” Hoheusle said.

Susan Kreimer is a freelance health care journalist based in New York.

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