Why Consumers’ Out-of-Pocket Costs Can Put Your System at Risk
A recent study connecting the lower use of primary-care services with higher patient out-of-pocket costs speaks to the need for providers to be more cognizant of their patients’ financial situation if they want to retain those patients as customers.
In the study, a team of researchers from medical schools at three different universities looked at the use of primary care services by approximately 13 million adults aged 18 to 64 who were insured by a large national commercial health plan. The study pool and period consisted of 142 million problem-based or preventive visits by those patients to about 250,000 physicians, nurse practitioners or physician assistants over a nine-year period from 2008 through 2016.
Even a small increase in patients’ out-of-pocket financial responsibility could translate into a big decrease in your patient population.
The researchers found that the rate of primary-care provider (PCP) visits dropped from 169.5 visits per member-year in 2008 to 134.3 visits per member-year by 2016. That’s a nearly 21 percent slide in the PCP visit rate.
Further, the study found that the percentage of patients with no PCP visit over a 12-month period rose from 38.1 percent in 2008 to 46.4 percent by 2016.
The researchers then looked at patients’ out-of-pocket costs over the same study period. They defined out-of-pocket costs at the total of a patient’s deductible, copayment and coinsurance for one visit. The average out-of-pocket costs for a problem-based visit, or a visit initiated because the patient was ill or injured, rose from $29.72 in 2008 to $39.09 by 2016. The researchers found the average out-of-pocket costs for a preventative visit, or a visit for a routine checkup or physical, actually dropped from $20.06 in 2008 to just $4.91 by 2016.
Knowing your patients’ price sensitivity is critical to their health and your business.
The researchers suggest that rising out-of-pocket costs for problem-based visits albeit low in terms of being more expensive—a less than $10 increase over nine years—contributed to the drop in the overall PCP visit rate.
“Adults may face greater financial barriers to seeking primary care, as deductibles increase and a larger proportion of adults are enrolled in plans including a deductible,” they said.
TAKEAWAY
What do the findings mean for you as a primary-care practice or a hospital or health system that runs primary-care practices under your delivery-system umbrella?
It means you should realize that even a small increase in patients’ out-of-pocket financial responsibility could translate into a big decrease in your patient population for those who need primary-care services when they are sick or hurt. Delaying care could exacerbate those medical conditions, and those patients could end up costing you more to treat under a value-based reimbursement contract.
Knowing your patients’ price sensitivity is critical to their health and your business.