The Affordable Care Act continues to bring millions of new patients into hospitals and medical practices by extending coverage to the previously uninsured. In fact, nearly 60 percent of primary care physicians are seeing more patients who are newly insured under a private plan or Medicaid. And it’s not just patient volume that’s changing — the way care must be delivered is changing, too, requiring more accountability and transparency on the part of providers.
To be sure, doctors are feeling that pressure. But how have these changes affected support staff at practices and hospitals?
Patients don’t understand their plans
Consider this: some sources report that more than 15 million Americans who didn’t have health coverage before the Affordable Care Act was signed into law were covered by the end of open enrollment in 2014. That’s great, but many of these patients are unclear about what is or isn’t covered by their plans.
As you well know, even people who have had health insurance their whole lives often have questions about the details of their coverage. So those who are new to the system understandably require explanation of certain aspects of what they’re paying for. Although support staff aren’t hired to be insurance educators for patients, they’re increasingly accepting that role during the check-out process, and those conversations take time.
Practices must decide which plans to take
Practice managers and administrators must navigate the particularities of individual plans offered on the new healthcare exchanges in order to determine which ones to accept — a time-consuming task under any circumstances, made more so by the sheer volume of new insurance offerings on the exchanges.
Collection is getting harder
The responsibility for collecting payment has shifted more heavily from insurance companies to individual practices and hospital staff as patient accountability for payment has increased with the rise in popularity of high deductible health plans (HDHPs). Indeed, as many as 17.4 million people held HDHPs as of January 2014. Today, billing department representatives must spend more time trying to hunt down payments from patients. With the size of the average deductible more than doubling over the last eight years — from just under $600 to over $1,200 — many patients experience sticker shock when their bill arrives, and may even avoid paying for as long as possible because they simply don’t have the money. And, by all accounts, HDHPs are here to stay.
Widespread pre-authorizations aren’t going away
Prior authorizations (PAs) for tests and procedures aren’t new, but the frequency with which these often time-consuming processes are required is increasing, resulting in millions of potential hours of lost productivity. According to one estimate, that adds up to 868.4 million hours of physician time, plus untold additional staff hours, spent on this task. Many expect the problem to get worse, with some physicians now facing PA requirements for generic drug prescriptions, or prescriptions for medications that patients have been on for a long time.
“Customer” is king
A key element of the ACA is the tenet that patient engagement and satisfaction scores — determined by patient survey responses and patient reported outcomes — will factor in to how hospitals and practices receive reimbursements going forward. That means that greater attention is now being paid to delivering a better patient experience, from more personalized attention by front desk staff and administrators to facility cleanliness, waiting room pleasantness, and more. With some experts predicting that as many as one-third of hospitals will close over the next five years, partly due to poor patient experiences and reviews, the importance of patient satisfaction has never been more important.
Securing patient data is growing more complex
HIPAA (the Health Insurance Portability and Accountability Act) has been around for nearly two decades, and when it was first passed, paper records for patients were the norm. Today, electronic records have taken hold, with nearly 71 percent of physicians having adopted EHRs at the end of 2014. Electronic records require careful security measures, including password management, standardized policies on who gets access to what information, and how records can be accessed (via mobile device, etc.) as well as regular assessments of security risks — not only to prevent breaches but also to make practices and hospitals both compliant with HIPAA and eligible to attest to meaningful use.
Medicare and Medicaid compliance programs are required, not optional
Due to ACA’s Section 6401 mandate that all providers establish a Medicare/Medicaid compliance program, support staff are now on the hook not just to establish such programs, but also to manage them in order to ensure proper billing as part of a waste-fraud-abuse-inefficiency reduction strategy. Effective compliance is also key to improving the experience — and ultimately, the patient-generated review of care — of patients who are covered under a Medicare or Medicaid plan.
Sounds like a lot, doesn’t it? Support staff — the unsung heroes of any medical practice — are facing just as much pressure as doctors because of the changes caused by healthcare reform.
Is your practice feeling the strain of increased patient volume? To discover how Everseat can help relieve the pressure of more appointments on your scheduling system, get in touch today. Everseat has helped practices nationwide reduce cancellations and missed appointments and improve the bottom line.