Patients’ Payment Burden Climbs After Health Reform
Written by Editor   
Thursday, July 16, 2015 02:15 PM
Quick Brief:  Out of pocket expenses have risen for patients since the implementation of health reform.  Copayments, coinsurance and deductibles have increased by 3.5% for established patients and 2.7% for new patients, mostly in the increase in deductibles.


Patients' out-of-pocket costs have risen for most office-based visits following the implementation of the Affordable Care Act (ACA), according to a nationwide study of physician practices, and the trend may lead patients to cut back on needed care.

"Across all specialties, between 2013 and 2014 the mean patient obligation" -- the sum of all copayments, coinsurance and deductibles -- "increased by 3.5% for established patients and 2.7% for new patients."

Most of the increase was in deductibles. The researchers determined that these rose an average of 9.5% for established patients and 7.9% for new patients. Copayments generally fell while changes in coinsurance were a mix of small increases and decreases.

The researchers culled data from 17 million patients and about 15,000 providers.

"For the office-based doctors, one thing that seems clear is patient collections are increasingly important,” the authors wrote noting that 20% to 25% of the total allowed amount now comes from patients. Those payments will becoming increasingly important to providers' bottom line, which means they'll need to pay more attention to billing and collection processes.

The researchers also looked at trends in payments to physicians by insurance carriers and found an overall upward trend of 2.0% for established patients -- defined as those who visited a provider at least once in the previous 2 years -- and 1.4% for new patients. Primary care providers saw a bump in payment of 3.4% for established patients and 3.8% for new ones.

Research has shown that out-of-pocket costs impact patient behavior whether that's asking for a generic instead of a brand name drug or delaying care, or even foregoing care.

As patients are charged more and more for their own care, a greater share of provider income comes from consumers. This trend, if it continues, could place providers at financial risk.

So, how should providers respond? "I think in the current environment, providers have an increasing need to make a case to consumers for the value of the treatment they are proposing,” the report said.  Providers will also be obligated to explain the rationale behind certain prices.  Providers have to be a lot more in tune with consumers concerns around cost. Transparency of cost becomes very, very important.