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Repeal of Obamacare Likely to Grow Number of Self-Pay Patients 

While Congress moves forward in their effort to repeal the Affordable Care Act (ACA), a new report points out that the changes anticipated appear to point to an increase in the number of self-pay patients; meaning less revenue for medical providers historically.  This analysis has been provided by accounting and consulting firm Crowe Horwath.  The report, “Self-Pay Becomes Ground Zero for Hospital Margins: Lower Net Revenue Realization Impact Follows,” used data taken from their revenue cycle analytics platform.  The report made use of the analysis of a sampling of 357 hospitals in states where Medicaid had expanded.

Hospitals in states that had expanded their Medicaid coverage between 2013 and 2016 witnessed their number of patients who were covered by Medicaid increase from 12.3 percent to 18.3 percent during that time.  During that same time, patient self-pay dropped from 7.4 in 2013 to 3.5 in 2016; a drop of 4 percent.  Crowe Horwath is now pointing out that with so much uncertainty in healthcare, that medical providers should prepare for growth in self-pay patients.

Medical provider cash flow is likely to be adversely affected, according to the report, as the average self-pay patient remains in the AR cycle for about 96 days whereas those with Medicaid balances typically only do so for about 64 days.  Not to mention the current trend of insureds moving to high-deductible health plans, an insurance model with a mix of self-pay and insurance coverage, is set to continue growing.  The Crowe Horwath analysis plainly states that the combination of growth in HDHP insurance policies added to a full repeal of the ACA will cause an increase in self-pay patients of 4.2 percent.  The report also points out that this situation will decrease revenue by 2.8 percent.

Crowe Horwath recommends several common-sense practices for providers in dealing with self-pay.  One thing that can be very helpful is to make use of tools that determine a patient’s capabilities for paying.  Another good practice is to create positive interactions pertaining to the financial portion of patient experience.  It is also valuable to train attention on those patients who have the ability to pay for their out-of-pocket expenses.  Providing multiple payment options, affordable payment plans, discounts and even help with Medicaid enrollment forms will all be beneficial.

Lastly, giving patients the advantage of price transparency and the opportunity to shop around and even the ability to negotiate prices will all help providers weather the storm on the horizon that’s been created by the rise of HDHP’s combined with the effects of the likely ACA repeal.

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