Another Unintended Consequence Of High Deductible Health Plans

It’s pretty clear that the fast moving trend to high deductible health plans is hurting the average patient. There are few plans through Obamacare that do not carry a high deductible and employers are aggressively embracing the HDHP, partly as defensive move against the 40% penalty tax come 2018. 

But here is a new twist (or one of those unintended consequences); patients can’t pay their bills incurred before meeting the deductible. Wow! What happened to their Health Savings Accounts? 

Sure glad health care is more affordable than it was six years ago. Between high out-of-pocket costs and limited networks with no out-of-network coverage, patients are being squeezed. 🤔

From The Healthcare Blog

The Self-Pay Paradox


One of the most important trends in healthcare today is the inexorable shift towards high-deductible health plans. Over the past few months, my colleagues and I have analyzed tens of millions of visits to practices using athenahealth’s practice management and EHR services to understand the impact that this shift is having. We believe there are some reasons for providers and practice leaders to worry–the average patient obligation has increased by 20% over the past 4 years, and the number of patients carrying large balances is increasing as well. We have also seen that practices’ ability to collect these obligations is highly variable.

Across our network, patient payments provide nearly one-fifth of physician income, with the median athenahealth provider failing to collect 30% of what patients owe. And the situation is getting worse. As the graphic below shows, patient deductible obligations are up 22% in the past two years–while commercial payments have grown only 4%.

My colleagues and I have studied these trends, and we’ve identified a few things that top-performing practices do to ensure that they are able to collect the dollars that they are owed. In fact, at every step of the collections process–from scheduling to follow-up months after a visit–top-performing practices take a different approach than others.

Jessica Sweeney-Platt is a lead with athenaResearch

There is another consequence in all this. More physicians knowing the high deductibles people face are requiring partial payment in advance of services. 

Obamacare made health care less affordable for anyone not receiving a government subsidy and that subsidy is paid by taxpayers who are seeing their premiums and out-of-pocket costs rise like no time in the history of employer health benefits (and I was there for most of that history). So while ten million Americans gained coverage, tens of million more have seen their disposable income go down as a result of major cost shifting. The struggling middle class has had its struggle made worse by the far flung direct and indirect impacts of the Affordable Care Act. 

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