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 health- care’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.