Michael Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab at Boston-based Harvard Medical School, and Jonathan Bush, CEO of athenahealth, penned a Health Affairs blog post examining how high cost sharing affects provider reimbursement.
In the blog, the authors cite a recent study of athenahealth claims data, which was used to examine out-of-pocket obligations for commercially insured patients from 2012 through 2016. The study included 125 million visits for ambulatory services, such as office visits and ambulatory surgical procedures, by 18 million patients across more than 1,300 practices. Ambulatory services delivered in hospitals were not included.
The study found an overall 20 percent increase in the average patient obligation per visit during the study time period, the blog's authors said. Specifically, 57 percent of visits in 2012 involved limited out-of-pocket charges for patients with costs at $35 or lower, compared to 50 percent in 2016. Over the same time period, the share of visits carrying a more than $200 out-of-pocket obligation for patients increased 23 percent.
The blog's authors said 2015 data was also used to determine collection rates after 12 months for various patient obligation size categories. The study found 93.8 percent of small patient obligations were paid within the 12 months, followed by 90.5 percent of medium patient obligations ($35 to $75), 83.7 percent of large patient obligations ($75 to $200) and 66.7 percent of very large patient obligations. For small patient obligations, 0.6 percent were written off as bad debt or abandoned, and another 5.6 percent were sent to collections. This compares to very large patient obligations, where the numbers were 16.2 percent and 17.1 percent, respectively.
"While we must reduce costs overall, any replacements for the ACA must consider all the downstream implications of such cost-reduction efforts on both patients and providers," the blog's authors wrote. "With a complete picture and full accounting of the interdependencies involved, policy makers and providers can take actions to counter potentially negative impacts with innovative solutions."
Read the full blog post here.