Expect 'reluctant' patients and fewer office visits with growing health savings accounts

Is the wrist broken? Some patients may wait-and-see. Others will 'doctor hop' for lowest prices.

Issue: October 2006

As consumer-driven health plans such as health savings accounts gain popularity, patients may make fewer office visits as they try to squeeze the most from their health care dollars. And physicians may find it more difficult to hold on to patients, says a practice management consultant.

If they have not already, orthopedic practices should start figuring out how best to manage the coming changes, said Susan Childs, FACMPE, senior consultant for the Coker Group, Alpharetta, Ga.

"The patient is going to want to save as much money as possible ... they're going to start shopping around for doctors," Childs said while discussing health savings accounts' (HSAs) potential effects on patient behavior for an audience at the recent BONES Society 37th Annual Conference in Phoenix.

'Doctor-hopping'

According to the Wall Street Journal, 27% of employers are "somewhat" or "very likely" to offer HSAs compatible with high deductible health plans (HDHPs) within the next two years, Childs said.

HSAs are tax-free savings accounts set aside for medical expenses. HSAs funds are intended to pay for the deductible portion of medical expenses, at which point health care insurance takes over. The point of creating HSAs is to lower overall costs to individuals, compared to traditional insurance plans. HDHPs are a type of consumer-driven health plan. Under current law, patients may open HSAs only in conjunction with HDHPs, and when they are not covered by low-deductible insurance, Medicare or Medicaid, or claimed as tax dependents.

The current maximum HSA contributions are $2,700 for individuals and $5,450 for families. The minimum deductibles are $1,050 for individuals and $2,100 for families.

Among the main concerns: If patients forgo office visits to save money, fewer office visits may result in increased telephone consultations and triage. To help busy orthopedic offices cope with the threat of lost traffic, Childs suggested confirming appointments, documenting and updating employees on what types of complaints and follow-ups get handled in the office, and using automated recall programs to schedule future visits.

Technology can help. Updated telephone systems, answering services, and Web sites can help office personnel handle more calls, help patients get information and assist in patient payments, she said.

Some patients will not seek care unless they absolutely must, Childs said. As an example, she cited a young patient with a broken wrist who is accustomed to co-pays and has never seen a $2,000 deductible. That patient would only seek care out of sheer necessity, she said.

Physicians need to get reluctant patient sinto their offices, she said.

"Even if I've already gone to the doctor and my wrist is feeling better and I'm supposed to go for a follow-up, why should I go?" Childs said. "So, you have to teach them why it is important that they return."

Marketing/customer service

Childs urged physicians and practice managers to market their practices confidently and creatively, to stay in business and provide the care patients need.

"The first thing to remember is, do not be intimidated," she said. "Patients are going to come in with all of these brand-new questions. We are the ones in charge. We are the ones who set the policies. It's just another kind of plan."

Customer service and personal attention are essential, Childs said.

"Be accessible to your patients for the answers," she said. They will remember you. They need help. It's a learning process for everybody ... the more personal the touch, the better. Patients are customers and they're looking for customer service. That's the name of the game."

Be sure that roles are clearly defined, especially between business and clinical operations. An adequate nursing staff is essential, especially for triage and fielding questions, she said.

To better retain patients, Childs suggested that orthopedists explore ancillary services such as urgent care and wellness centers, podiatry, bone densitometry, MRIs and CT scan services.

More patients paying more

Childs also cited the advantages of being the first practice to participate in a new managed care plan.

"A lot of times, your smaller payers will have a very beneficial pay schedule. ... They're trying to get people on because they're building their network ... So, look for those new plans. Call your local employers and see which plan/coverage they're dealing with."

Physicians and managers must review payer contracts at least every 18 months, along with payment, collection and privacy policies. They have to contend regularly with various issues, such as rules on charging insurance companies for telephone consultations, which vary regionally and are changing rapidly, Childs said.

For more information:
Childs S. HSAs and how they affect patient behavior. Presented at the BONES Society 37th Annual Conference. May 21-23, 2006. Phoenix.