ONE TREND THAT PUTS FINANCIAL PRESSURE on both clinical laboratories and pathology groups is the growing number of patients who have higher deductibles. This means labs must work harder and smarter to collect all the money that is due them from the patients they serve.
How advanced is this trend? Last fall, the Kaiser Family Foundation released a report noting that 2016 was the first year where 51% of workers (more than half) in a single coverage health plan must pay at least a $1,000 annual deductible. For workers at small firms (three-199 workers), this number is now 65%.
There’s a similar story in the enrollment growth of high-deductible health plans (HDHPs). According to Kaiser, as of 2016, 29% of workers with insurance now have HDHPs. That number is a 50% increase from 2014, when just 20% of workers had HDHPs.
These are the market statistics that validate the reality that clinical labs and pathology groups experience daily. More of their patients have health insurance that requires them to pay substantial amounts of their lab test bills themselves, before insurance coverage kicks in. For patients in high-deductible health plans with an annual requirement of $5,000 to $10,000, that means the lab must collect 100% of the lab test bill, particularly in the first half of the year.
Labs are not the only providers struggling with the trend of higher patient deductibles. Hospitals have been hit hard by the need to collect greater amounts of money directly from patients. In a story published this month by Modern Healthcare, Jase DuRard, Chief Revenue Officer for revenue-cycle vendor AccuReg said, “About five years ago, insurers paid about 90% of hospital claims, with patients responsible for about 10%. Today, the mix is 70% by insurers and 30% patient out-of-pocket.”
There will be substantial changes in the financial management of the nation’s clinical labs and pathology groups when the patient-pay proportion of their revenue climbs to 30% or more, as is happening at hospitals. Among other things, it will be necessary for labs to collect payment from patients when they show up to have their specimens collected. Thus, it would be timely for all labs to develop strategies to handle collecting monies owed by patients.