Anderson said St. Louis-based Ascension Health is seeing exchange enrollees with health-plan deductibles as high as $10,000.
It's the world for which Gwinnett Medical Center in Lawrenceville, Ga., has steeled itself, said Cynamin Kinard, director of patient financial services at Gwinnett.
Gwinnett, which is merging with Northside Hospital in Atlanta, just hired its fourth financial advocate to call all non-emergency hospital patients facing high-cost procedures and diagnostics, such as MRIs, CT scans and surgeries, Kinard said.
The key to surviving this era of high-deductible plans is to vet patients before their treatment and share with them as accurately as possible how much they can expect to pay out of pocket, she said. “If we didn't do that, our bad debt would be increasing,” Kinard said.
Gwinnett is a two-hospital system, with its 552-bed flagship hospital located about a half-hour outside of Atlanta.
The system's financial advocates call patients between three days and 24 hours before their procedures. They crunch the numbers with patients to show what their insurance will pay and what they will be on the hook for, Kinard said.
The advocates are armed with a suite of predictive, revenue-cycle software from RelayHealth, a unit of McKesson Corp. It pulls and evaluates credit scores to determine what the patient is able to pay and, from their credit history, their willingness to pay for the care they are about to receive.
They also try to get the patients to pay deductibles via credit card over the phone.
If the best time to collect out-of-pocket costs is before the visit, the second best time is before the patient leaves the hospital, Kinard said.
For that reason, Gwinnett has a process to send financial counselors to the bedsides of some patients to offer them the opportunity to pay their out-of-pocket costs on the spot. Cash, check or credit cards are all accepted, she said.
Kinard said the hospital very rarely sees a patient anymore who doesn't owe something for care.
In December, Gwinnett added payment financing options from Charlotte, N.C.-based AccessOne that provides patients with a 40% discount on their bills if they pay at the point of service and an interest-free option with a 10% discount if they pay in full within a year, she said.