Last night a member of my immediate family spent over two hours in urgent care - two doctors, four nurses working simultaneously, two separate blood draws, multiple tests and protocols.  It’s likely the deductible was met it that one visit (our deductible starts in September). I can only imagine the bill next month.

Every day I work with physicians and other providers who are concerned about their declining incomes and aging accounts receivable.  “I’m working harder than ever,” lamented a doc I talked to last week.  “Charge volume is up, so why are cash receipts down?”

Indeed.

Copays, deductibles and coinsurance rates are skyrocketing, the result of which is the financial risk of providing quality care is falling to physicians.  Independent providers are especially hit.  Many patients don’t even reach their deductibles until late in the year.  The nature of the revenue cycle generally means patients don’t even see a bill until after insurance has responded, often 45-60 days after the DOS.  Add to that the fact that much of the U.S. patient population has been conditioned to pay their healthcare bills last, and you have a perfect storm for patient responsible balances getting way out of control.

It used to be that providers could count on insurance reimbursement to cover the cost of doing business and provide a decent living.  When patients paid their bills – that was happy gravy.  Not so any more.  It’s time to embrace the fact that the self-pay portion of the A/R plays a very real and significant role in the financial health of any healthcare organization, and get creative about encouraging patients to stay current.

You really care for your patients.  That’s good.  But getting paid last so that every other vendor in your patients’ lives can get paid first is not your calling.

Take a few minutes and check your AR by payor class.  Review self-pay aging buckets for total dollars, number of claims, and average dollars per claim.  You may be surprised.

‍