High-deductible plans could push down hospital credit ratings, Fitch warns

The shift to high-deductible plans is putting a strain on patient volume and financial performance at U.S. hospitals and could drag down credit ratings, one ratings agency warns.

High-deductible and consumer-directed health plans are becoming increasingly popular, both among employers trying to manage costs and on the lowest cost tiers of the online insurance marketplaces.

But Fitch Ratings sees the trend as an overall negative for healthcare providers, as these plans increase the focus on pricing transparency, drive down consumer demand for healthcare services and raise bad debt from unpaid bills.

Thirty-one percent of employers offered a high-deductible plan in 2011, an increase from 4% in 2005, according to Fitch, which cited a Kaiser Family Foundation survey. That number is only expected to rise, and an increasing number of companies now offer these plans as the only option for employees.

Unsurprisingly, when patients pay more out of pocket, they're more price-sensitive and more aware of what they're being charged. They're also more likely to delay non-urgent care.

That means utilization patterns could change as consumers shop around for the best deal and take into account price and quality information, Fitch says.

Some health systems are already getting in front of these trends by allowing patients to search for price information before their procedures. They're also being more proactive about billing and collections—such as increasing communication with patients and introducing more payment prompts, such as e-mail alerts.

Others are getting into the financing business, offering loans to patients either directly or through a third party. But the practice has been controversial as some regulators fear the potential for exploitation is high.

Nevertheless, the ability to walk that line will be critical for hospitals' financial performance, Fitch says, as well as the ability to flex staffing to meet fluctuating demand throughout the calendar year.

Follow Beth Kutscher on Twitter: @MHbkutscher