Nearly 80% of U.S. employees have a health plan requiring they pay at least $1,200 of medical expenses annually before insurance contributes its share. An astounding 40% have high-deductible health plans with larger obligations, noted Ed Swager, CEO of Radiologic Associates of Fredericksburg (RAF).
In response to the rising costs of deductibles, RAF and the outpatient centers it partners with, have been using an electronic check-in system and no-interest payment plans to make health expenses more understandable and affordable for patients at Medical Imaging of Fredericksburg, the Imaging Center for Women, Medical Imaging at Lee’s Hill, Medical Imaging of North Stafford, and Virginia Interventional & Vascular Associates (VIVA).
“Our check-in system helps clarify for patients what their financial obligation is based on their insurance, and our payment plans enable patients to pay these high out-of-pocket expenses over time, without interest, and still have their procedures now when they need them,” Swager explained.
Recently, Swager spoke with Imaging Advances about the reasons why high-deductible health plans have become so prevalent, what their impact is on patients and healthcare providers, and how RAF and its partners are working with patients to manage health expenses.
Until the 1990s and early 2000s, most employer-sponsored insurance plans paid 80% of an employee’s medical costs, the employee paid 20%, and out-of-pocket expenses were relatively manageable for American workers, Swager explained. The concept of high-deductible health plans sprang from the idea that costs could be lowered if consumers had greater responsibility for their overall expenses. For example, a patient under the 80/20 plan who was likely to visit a doctor at the first sign of possible flu would be more inclined to wait to see if it were a simple cold if a high deductible had to be met.
Today the federal government spends $3.8 trillion on healthcare annually and the pressure to contain costs continues to grow, he noted.
High Deductibles Impact
The major concern with high-deductible health plans is that some patients are delaying important medical services. In fact, a Reuters survey estimates that 24% of people have cancelled or postponed healthcare because of costs, Swager said. He added that many high-deductible health plans offer reasonably priced preventive care and lower monthly premiums but require patients to meet deductibles as high as $2,000 to $10,000 before their insurance kicks in, which helps patients in catastrophic medical situations but not most others.
“Patients delaying healthcare because of costs is a real problem because early diagnosis is critical to the treatment of heart disease, cancer and many other serious conditions,” Swager explained.
RAF Partners Respond
Swager noted that VIVA, RAF’s interventional radiology and vascular surgery division, and Mary Washington Healthcare (MWHC) implemented a program to address the high-deductible challenge. Together, RAF and MWHC deliver services to four medical imaging centers in Fredericksburg, Spotsylvania and Stafford.
“We recognize the burden on patients with high deductibles,” Swager said. “What we have done is to use technology and a payment process to help our patients.”
The technology is Phreesia, an electronic check-in system that collects relevant clinical and demographic information from patients. Phreesia automatically communicates with a patient’s insurance company to determine benefits, co-pays and deductibles. “Through Phreesia, we can tell patients their current deductible and balance. We use this to let patients and our staff members know what insurance requires and the portion expected at the time of a visit,” Swager said.
Patients also can pay part of their deductible now and the rest later through established payment plans. Swager can relate to the need for payment plans because of his sticker shock over the $6,000 deductible required for his wife’s recent back surgery. “That is a frightening amount when you consider that the average family is making $57,000,” Swager said.
“We know our services and healthcare in general are costly. Patients can pay a portion at the time of their service and we also offer payment plans. So when you come in for an MRI, PET or other procedure, you can pay over time with no interest,” Swager explained. He also noted that MIF and VIVA’s outpatient facilities help conserve healthcare spending by offering lower-cost settings for medical procedures compared with inpatient hospital stays.
“With these processes in place, our facilities are achieving patient satisfaction ratings in the top 95–99 percentile compared with other providers,” Swager said. “We are trying to ease the burden we all face with healthcare, through technology and payments over time.”