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December 01, 2016 at 11:22 AM
U.S. hospitals may get less than half of what they think the patients are responsible for paying out of their own pockets for outpatient care, and less than one-third of the amount owed for inpatient care.
Analysts at Chicago-based Crowe Horwath LLP, an accounting firm, have reported that finding in a look at how commercial health plan efforts to shift more responsibility for payments to patients have affected U.S. hospital revenue.
Insurers describe that approach as “increasing patients’ out-of-pocket costs.” Health policy specialists also refer to that approach as “giving patients more skin in the game.”
Crowe Horwath analysts measured how much of the out-of-pocket cost total hospitals really get by reviewing bills for commercially insured patients at 660 hospitals in 42 states.
Related: Health plan coverage gaps give hospitals sunburn
Hospitals develop “chargemaster” rates, or list prices, that few insured patients actually pay. Health plans usually use provider network agreements and other mechanisms to set the actual reimbursement rates. The Crowe Horwath analysts based their work on the actual allowable rates for insured patients, not the chargemaster rates.
In theory, patients’ responsibility for allowable inpatient bills increased to 12.1 percent of the total in the third quarter, from 10.2 percent in the third quarter of 2015.
The patients’ responsibility for allowable outpatient bills rose to 26.9 percent, up from 23.3 percent.
But, in the third quarter, when the hospitals in the study billed insured patients, they collected only 41 percent of the patient responsibility amounts for outpatient care, and only 31 percent of the patient responsibility amounts for inpatient care.
