Introduction
Health plan deductibles are rising, and patient self-pay of deductibles is typically difficult for doctors to collect, meaning that increasingly more doctors may lose money on patient deductibles. This is according to athenahealth, a Watertown, Massachusetts, company that provides cloud-based services for medical groups.
"Benefit plans are shifting to include higher deductibles," says Tricia Andriolo-Bull, Vice President of Payer Strategy at athenahealth. "There's more cost-shifting in co-pays and co-insurance. The higher deductibles are a good way for employers to keep premium rates down. But any increase in self-pay is bad for the physician because it's hard to collect."
Athenahealth examined over $10 billion in adjudicated claims paid by private insurers to over 33,000 providers, from 2009 to 2011 (See pdf, Published with permission from athenahealth). The providers, who used athenahealth's services, were from 48 states and practiced in a range of private and not-for-profit settings.
Deductibles as a percentage of contracted rate have risen by 47% in the Northeast from 2009 to 2011 and by 20% in the rest of the country. Deductibles as a percentage of contracted rate rose the most in South Dakota (18%), Wyoming (18%), Missouri (15%), and Oregon (15%).
"High-deductible health plans are just starting to take off," says Andriolo-Bull.
