Hospitals struggle with collection rates amid increase in patient out-of-pocket costs, data show

Patients continue to take on more financial responsibility for their care due to more people participating in high-deductible health plans, as well as those who are gaining insurance coverage through the ACA. However, healthcare providers often struggle with collection rates as they try to adapt to increasing patient responsibility amounts for insured self-pay co-pays and deductibles, according to the third-quarter 2016 edition of Crowe Horwath LLP's hospital benchmarking data.

The data comes from Crowe Revenue Cycle Analytics, a benchmarking solution from Crowe. Crowe RCA compiles and organizes a daily feed of transactional-level data from the patient accounting systems (PAS) of more than 660 hospitals. Crowe then performs an account-level link of the PAS data to payer 835 electronic data feeds (which identify the patients' financial responsibility for the claims, such a deductible and co-pay amounts) from 199 of these facilities. This account-level linkage allows for the creation of unique analytics associated with self-pay after insurance (SPAI) dollars.

The latest quarterly Crowe RCA Benchmarking Analysis, "Patient Financial Responsibility on the Rise: Providers Face Net Revenue Impacts," details the analysis of data examined through Sept. 30, 2016.

The analysis found that in the past year, insured patient financial responsibility has grown from 23.3 percent to 26.9 percent for outpatients and 10.2 percent to 12.1 percent for inpatients.

Additionally, as a result of lower collection rates from patients, compared with insurance payer collection rates, overall managed care net revenue has been reduced by 2.5 percent for outpatients and 1.4 percent for inpatients, assuming contract rates were unchanged between the third quarter of 2015 and the third quarter of 2016, the data show.

Click here to access the full analysis.


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