How consumerism in healthcare will affect your organization in 2020
One thing is clear: the push toward consumerism in healthcare will continue in 2020. The new year will see further ways to empower patients with the services and cost information they are demanding. But, how will your practice experience the changes that 2020 will bring?
Let’s look at three categories:
Increased patient access to care via telehealth and remote monitoring.
Patient rights to obtain payer reimbursement information.
The possible rise in patient debt due to short-term insurance plans.
Providers will benefit from increased access to care through telehealth and monitoring
New codes to accommodate e-visits and monitoring by CMS and the AMA will give providers better insight into their patients’ health and another revenue stream.
Telehealth will grow, especially among Medicare beneficiaries
In April 2019, CMS allowed Medicare Advantage plans to offer telehealth as a standard, rather than supplemental, service beginning January 1, 2020.
According to a leading telehealth provider, reimbursement is available in all 50 states and commercial payers are increasingly covering visits. For a complete list of telehealth service codes available in 2020 by CMS, visit the website. In addition to those offered in 2019, three new codes have been added for opioid counseling in 2020: G2086, G2087 and G2088.
New codes bring revenue opportunities for providers
The AMA announced in September that they added six new codes for e-visits in 2020:
CPT codes 99421, 99422 and 99423 will apply to communication initiated by the patient.
CPT codes 98970, 98971 and 98972 will allow communication with a non-physician healthcare professional.
In addition to new e-visit codes, they also announced several new codes for self-monitoring and remote monitoring.
CPTs 99473 and 99474 have been added to report ‘self-measured’ blood pressure monitoring.
CPT codes 95700-95726 will be used for long-term electroencephalographic (EEG) monitoring performed by a qualified health provider. Four older codes in this range have been deleted for the update.
Providers will be watching price transparency mandates and legal actions
The final rule released by CMS this past November is sure to bring a lot of headlines in 2020 as it relates to price transparency, and provider organizations will be paying attention.
Hospitals already post fees for common services and procedures online, but the final rule states that in 2021 they will be required to post the rates they have negotiated with payers. Within hours of the announcement, the Federation of American Hospitals announced that they would be joining a lawsuit to stop the implementation of the new rule.
How will this affect independent provider organizations? There is another rule proposal that will hit them closer to home. It would require payers to publish the rates they have negotiated with individual providers. Although an implementation date has yet to be announced, it is logical to think that if the hospital rates are published, the provider rates would not be far behind.
Organizations like the AMA will be following the developments of reimbursement reporting closely, as will the media. Increased press coverage of healthcare costs will likely increase the price sensitivity of consumers. Practices may want to consider implementing technology tools sooner rather than later to help answer questions patients will have about price and options available to help them pay.
Providers may see an increase in slow patient payments and bad debt
At the end of 2018, access to short-term health plans was expanded by executive order. It is feared by some in the industry that many patients purchasing these plans for the first time in 2019 will be affected by unexpected coverage shortfalls. According to a recent post on the Healthcare Financial Management Association (HFMA) website, consumers looking at their health insurance options on the federal marketplace may be redirected to other enrollment sites, some of which allow short-term plans with significantly cheaper premiums.
The downside for consumers is that short-term plans do not offer the same benefits of ACA plans such as preventative care, maternity benefits and can discriminate against pre-existing conditions. Unfortunately, the lack of coverage will likely translate into patients with unexpected medical bills who are unable to pay the hospital or their provider.
Organizations may want to consider a plan of action to manage an uptick in patient inquiries after insurance adjudication. Convenient and flexible payment options are one way to help patients manage unexpected medical bills.
The bottom-line for healthcare providers in 2020? The changes precipitated by the patient-as-consumer mindset will bring both opportunities and challenges.