Healthcare facilities need to do a better job of segmenting individuals who are true “self-payers” for their hospital bills against those who are “self-payers after insurance” (SPAI), which includes those with high-deductible health plans (HDHPs), according to a benchmarking report released this month by Crowe Horwath.
True self-pay accounts, generally those without insurance, only pay six cents for every dollar they are billed, compared with 15 cents for SPAI individuals, according to the report, which analyzed data from 172 hospitals, each with more than 125 beds. Only 74% of those facilities were segmenting the two groups into different “payment experiences.”
Not surprisingly, the collection rate among SPAI patients declines as the balance on their hospital bills increases, both for inpatient and outpatient procedures. On inpatient procedures where the balance is below $1,200, the payment rate for SPAI is 40.1%, but when the balance increases to $7,500, the payment rate drops to 10%, according to the report. For all balances, the average payment rate on in-patient procedures is 10.9%.
For outpatient procedures, the average payment rate is 18.2%. For balances between $1 and $5,000, the payment rate is 23.7%. For balances between $5,001 and $7,500, the payment rate drops to 4.7%.
Parsing accounts based on patient balance will prove a particularly insightful analysis for any nance team and likely will create a more reliable collectability factor based on historical experience.
One of the takeaways offered by the report is for hospitals to incorporate financial counseling into the “point-of-service” collection program to help patients determine the best course of action.
