Self-Pay is New Way: In Imaging Economics


As seen in the January/February Issue of Imaging Economics 

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The Last Word: A Take on the Radiology Community
Self-Pay Is New Way
by Chris Christenberry
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Patient responsibility is becoming a major player, even MVP, in health care.

As reported in the Wall Street Journal and the New York Times, the Kaiser Family Foundation Health Research Survey reported that health care insurance premiums paid by employers rose by 8% in 2011. The “WOW” factor is increasingly more powerful when paralleled by the fact that premiums should have slowed as more employers elected to offer high deductible plans. The rapid growth of both employer premiums and high deductible plans foreshadows the upcoming trend for health care providers, that patient responsibility will become a major player, even MVP, in health care discourse.

I have the unfortunate dilemma of balancing health care dollars. On one hand, my facilities and the health care clients we serve face continuous reimbursement cuts. On the other hand, our company and employees are paying more each year for our own health care. And yes, our premiums rose by 8% last year as well. Over the past 5 years, we have seen close to 25% decreases in payments. Imagine the impact a quarter of your paycheck disappearing would have on you. Now imagine your expenses increasing the same amount, too. It’s a truly unfortunate dilemma, so what is the key to combating this situation?

With the unique vantage point I hold for both sides of the provider-patient relationship, I understand the challenges the nation faces in dealing with limited health care dollars. You have heard it before, “the US system is broken.” Indeed it would seem so, as one side of the political spectrum screams for our government to pay for health care it obviously cannot afford while the other side of the spectrum demands that patients pay for their own care. So what happens when these patients must resort to this?

In a more perfect world, void of the challenges that our current system faces, companies and the government would be able to afford catastrophic health care policies. By catastrophic, I mean big-ticket health care events such as hospitalization, debilitating diseases treatment like cancer care, or end-life events. Large health care insurance companies could use the actuarial tools their cousins in the life insurance industry use. In other words, if it is true as the pundits say that “most of the health care costs occur the last year of one’s life,” then the health insurance companies could surely hedge for a catastrophic event in a patient’s life; however, doing so would still require the patient to take on some responsibility.

Patients would be required to pay for normal doctor visits, medication, and diagnostic testing; however, these patients, or their companies, could be awarded reduced premiums by maintaining healthier lifestyles and receiving wellness check-ups, in much the same way that good drivers are awarded lower costs in the auto industry. Patients paying for this level of health care would create a market where they are more cognizant of their health dollar. In the near future, we’ll see tools designed to help patients understand the true costs of their health care, thus enabling them to negotiate what they pay out of pocket.

Hogwash, one might say to the notion of patients actually paying for their own health care. In reality, self-payors are growing increasingly more popular as health care players. With 17% of employees in high deductible plans, these plans have grown 25% in the last year. The average family of four already pays close to $3,500 out of their pocket for their care, and you can ask any physician group and they will tell you that the self-pay component is growing. Allow me to suggest that providers, insurance companies, and patients accept this new reality, because in the same way that paper phone books, Blockbuster, and disposable cameras have become obsolete, so will the notion that patients will be protected by their insurance, so as not to have to pay for a large portion of their health bill. Yes, patient responsibility for payment can seem daunting, like picking up the tab for an expensive dinner you know you cannot afford, but forward thinking is the key. Self-pay is the new player, and price shopping is the winning game plan.

Chris Christenberry is CEO of Atlantic Health Solutions based in Tampa, Fla.

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