Emergency Medicine's New Self-pay Patient

By John Holstein, Director of Business Development

The Affordable Care Act (ACA) continues to bring a cascade of changes into the constantly evolving health care landscape. Below are just a few of these changes that are, and will continue to impact emergency medicine:
1. Out-of-network and balance billing of patients.
2. The continual boom of the urgent care industry.
3. Medicaid expansion and changing payer mixes.
4. Hospitals moving into the insurance business.
5. Demand for quality and value metrics of care.
6. Telemedicine and its impact on the care continuum.
7. The retailization and commercialization of health care.
8. Dramatic increase in the high deductible insurance plans.

It is particularly the latter issue, namely the dramatic increase in high deductible insurance plans that specifically highlights one of the biggest challenges in the emergency medicine industry, i.e. the self-pay patient. The self-pay patient has always been troublesome for emergency medicine, frequently characterized as the "no-pay" patient. The ACA and the retailization of health care introduced a new “high-deductible self-pay patient.”

Now more than ever, managing self-pay patient accounts requires versatility, creativity and updated revenue cycle management technology. It demands numerous patient touch points, flexibility offered in patient portals, and versatile, knowledgeable, and educated patient service personnel. Understanding the nuances of the patient's health care world demands the most sophisticated people equipped with the best technology in the physician revenue cycle business. The high deductible patient changes the payer mix of every emergency medicine practice and therefore directly impacts revenue, particularly cash flow, for at least the first quarter of the year. Engaging these patients is a necessity, but new tools are required so these patients do not slip past the emergency department practice and into a collection agency's hands, where difficulties in collections can magnify. The traditional way of attempting to collect self-pay dollars has no place with the high deductible patient.

If the high deductible patient is not properly engaged, and in fact does enter into a late collection status, it could potentially be a revenue problem in lost, or at best, delayed cash. Second, an emergency department practice will definitely have a public relations problem to address, as these kinds of complaints are commonly presented to hospital administration "before" a practice even knows about them. Third, the practice is now looking at a higher fee from a collection agency, further magnifying its revenue issue. This can quickly become a big problem, but can be avoided if the proper tools and technology are utilized by qualified and very knowledgeable patient services individuals.

Zotec Partners (Zotec) brings all of these parameters to the table for an emergency department’s success. Our patient services staff are superbly qualified and knowledgeable in today's patient issues, with the high deductible patient being one requiring particular focus and sensitivity. The high deductible patient presents a new and different challenge, which Zotec addresses quickly using the proper protocols and unique collection tools. We are armed with the most sophisticated and versatile technology available in the industry; designed and implemented for this specific patient population. We “touch” the high deductible patient more than seven times compared to the traditional two statements and a letter utilized within the industry. We also provide easy online payment plans that are linked to the patients HSA account (if applicable). The high deductible patient is contacted early and often.

Of critical importance to your success is that our technology was developed from a knowledge base "within" the insurance industry. Zotec’s technology is based on direct knowledge of how insurers respond to physician practices and their patients. The technology is also proprietary, and constantly updated and adapted to today's changing health care environment by our own development staff. Highly qualified people, using industry leading technology, all grounded in the industry's first, voluntarily established compliance program provides emergency medicine physicians a standard of excellence and performance that is unmatched and continually poised to address the next phase of the ACA. Your revenue is your practice's life-blood. Protecting and improving on it is our service commitment to you.