Co-Pays, Regulations a Challenge for Specialty Practices
In an interview, two practice owners explained the struggles of proper revenue cycle management.
- The increased cost of health insurance has a wide reaching impact on the industry. While it would seem that higher-co-pays, for example, would help increase revenue, the opposite can be seen. This is especially true for smaller and specialty practices that need to ensure they are capturing the proper revenue from every patient.
Recently RevCycleIntelligence.com interviewed two healthcare professionals that run their own practices and are affected by co-pays and the increased cost of healthcare. We spoke with Jennifer Welsh, MSPT OCS COMT ACT, a physical therapist and the owner of Performance Physical Therapy in Virginia and Larry Maurer DPM, a physician and the owner of Washington Foot and Ankle Sport Medicine in Seattle. Both individuals are facing challenges with revenue decreasing and the cost of doing business increasing.
One of the biggest obstacles is co-pays and deductibles. According to Welsh, whose practice can see patients multiple times a week, the rising out of pocket costs is having a direct effect on a patient decision to get care.
“It’s a big financial investment but it also deters patients from even coming in to the clinic because they don’t want to pay,” Welsh said. “If you see an orthopedic surgeon, for example, there is a co-pay every six to eight weeks, but for us you could be coming multiple times a week, which highly increases the investment for the patient and it is difficult to want that in their healthcare.”
Maurer has seen a similar trend in his practice. He agreed that co-pays can be a deterrent but for him, it involves patients coming in to address a fractured ankle or broken toe in four weeks instead of four days because they do not want to pay.
“It shows up as delayed treatment,” Maurer said. “People break their toes and they are pointed at 90-degree angles but they don’t come in. When they eventually do, it’s a more complicated treatment because it has started to heal in that position.”
He added that the best way to combat this is by educating the patients when they come in to ensure they understand what the co-pay is, what the deductible is and ensure they know what their financial obligation will be. The office has financial policies posted and education pieces available for this purpose and the practice is sure to contact any insurance provider to get the proper quotes and inform the patients of what is and isn’t covered.
Both Welsh and Maurer also pointed to the changing regulations of the healthcare industry that are making operations and revenue creation more complicated and how insurance providers are setting rates.
“As a small practice I am basically stuck. I don’t have a lot of pull,” Welsh said. “Some of the bigger providers that have a huge presence, they can negotiate some of their contracts, but most of it is still set by the insurance companies.”
Maurer added that for his organization, it has become a challenge to keep up. Insurance companies are constantly changing the rules to billing and claims are routinely denied because the company has changed “something in the process” and now a delay is created while the practice tries to figure out what it is.
Making matters worse, the elimination of certain codes has taken a bite out of business. Maurer said that Medicare – and many insurance companies after that – eliminated the consult code which offer specialty doctors used for a consult to get paid a higher rate because of the complication of the patient and the treatment. Without that code, there has been a significant reduction in Maurer’s revenue.
For all practices, staying ahead of changing regulations is critical. For smaller practices this can be a challenge but is a necessity to remain successful.
