From The Editor | December 16, 2014

Health Providers Need To Get With The Times

ken congdon

By Ken Congdon

Well, it’s that time of year again. Strangely enough, I’m not referring to the holiday season (although I am brimming with yuletide cheer.) No, it’s the time of year when our publishing company renews its employee health insurance for the coming year. We’re currently in the midst of our open enrollment period for 2015 healthcare benefits, and for the first time, we have a choice between two different plans — a traditional PPO (Preferred Provider Organization) plan or a QHDHP (Qualified High Deductible Health Plan) with an accompanying Health Savings Account (HSA).

I was initially intrigued by the QHDHP option for a few reasons. First, my family and I fortunately haven’t been heavy healthcare users historically. If our track record holds true in 2015, the QHDHP would definitely be the more cost-effective option. Second, I liked the idea of being able to use an HSA (and the debit card issued with it) to pay for things like office co-pays and prescription drugs. I also liked the idea of having the funds in an HSA accrue over time, and the fact that the money in the account is mine — it isn’t paid to the insurance company as a premium. Third, and most importantly, I honestly think high-deductible health plans are where the payer market is headed. In a few years, I believe the majority of health plans purchased will be of the high-deductible variety. I figured I might as well become an early adopter and start getting comfortable using this type of plan.

However, then I realized something. While I might be ready to embrace a high-deductible health plan and HSA, many of the providers in my region are not. Let me explain. I live in Erie, PA — a city with a population of just over 100,000 tucked in the Northwest corner of the Keystone State. It’s not exactly a rural locale, but it’s not a booming metropolis either. Like most of the industry, healthcare providers (both large and small) in Erie are painfully ill-equipped to deliver price transparency of any kind. I started testing the waters in this regard over a year ago. I needed to have an endoscopy performed and I called a few hospitals and imaging centers in my area to see if I could obtain pricing for the procedure up front. Not surprisingly, my question was met with utter confusion. “You don’t need to worry about that. You have insurance,” was the response I received. Yikes.

Being unable to secure pricing for healthcare services up front can make it challenging to manage a high-deductible health plan as efficiently as one would like. However, this issue isn’t unique to Erie. It’s a universal problem that the healthcare industry and federal government are starting to address. Through open data initiatives and mandates, healthcare price transparency is starting to improve, albeit slowly.

Technology-Averse Providers Create Obstacle To HSA Adoption
There are other issues common to Erie and other suburban/rural areas that also aren’t harmonious with high-deductible health plans — issues that most likely won’t be addressed by industry-wide mandates. For example, the Erie area still has a large population of small, independent physician’s offices in practice. Don’t get me wrong. I think this is a good thing. In fact, my family and I are happy to call ourselves patients of some of these independent practitioners. The problem is the complete lack of technology in use at many of these facilities.

Take my family doctor, for example.  I think she’s a fantastic PCP. My wife and I have been patients at her two-physician practice since we moved to Erie nearly a decade ago. However, despite the Meaningful Use incentives and pending penalties, her practice has yet to adopt EMR technology. Instead, she continues to run a practice that is completely paper based. This has been a bone of contention between me and my doctor for the past several years. As a journalist that covers the health IT space, I know the benefits EMRs (when implemented correctly) can provide physicians and their patients. I feel my health data will be more accurate and accessible if it’s stored electronically.  Moreover, I selfishly want to enjoy the added convenience complementary technologies such as e-prescribing, electronic lab orders/reporting, and a patient portal can deliver.

The lack of EMR technology isn’t even the worst of it. Her practice also has no payment processing technology in place. The office can’t process credit or debit cards — it’s a cash- or check-only operation. I can’t tell you the number of times I’ve gone to her office without the cash on hand to pay my co-pay at the time of service. The solution? I’m sent home with an invoice and I am forced to send my $10 co-pay by mail. This is not only inconvenient for me as a patient, but it interrupts her cash flow and unnecessarily consumes the administrative labor of her office staff.

One might think the absence of payment processing technology at her office is an anomaly. However, with small, independent practitioners, it’s more common than I’d care to admit. I see two other healthcare specialists (a dermatologist and a gastroenterologist) that are also unable to process credit or debit cards (on the bright side, these two offices have implemented EMRs).

I realize healthcare providers are laggards when it comes to technology adoption, but this is inexcusable. The ability to process credit and debit cards has become a customer expectation of almost every retailer and service provider. (How many gas stations still exist that don’t offer pay-at-the pump technology?) Furthermore, providing robust payment processing capabilities has become as easy as plugging a device into a smartphone. In fact, the technology is so mature, that credit and debit cards are on the verge of becoming obsolete with the emergence of services like PayPal and Apple Pay. Still, many independent physician practices have yet to offer this basic customer convenience.

How am I supposed to use my HSA debit card to pay for office co-pays or other medical expenses when my providers can’t process it? The answer? I continue to pay the provider by cash or check and reimburse myself from my HSA account using the online portal. The burden falls on me, the patient, to transfer the funds and balance the books. While it may show laziness on my part, I can tell you that the chances of me manually and regularly reconciling medical expenses from my personal bank account with HSA funds are slim to none. Therefore, much of the benefit and convenience I anticipated by leveraging an HSA goes out the window. In fact, it now becomes more of a personal administrative annoyance than a compelling option for healthcare expenses.

There is, of course, another option. I could switch doctors and go with providers that have the technology in place to make the QHDHP and HSA function as seamlessly as intended. This is not something I want to do, or am willing to consider at this point in time. However, it’s a possibility I will continue to monitor, and it’s a reality small, independent physician practices should be preparing for.

For now, I still have a traditional PPO option at my disposal. However, this is a luxury I (and many other Americans) may not have in the very near future. As more policyholders move to high-deductible health insurance plans, basic conveniences like credit/debit card processing will become more important factors as patients consider their health provider options. Small, independent physician offices need to get with the times and make the investments necessary to cater to customer demand. If they don’t, they may soon go the way of those gas stations that refused to provide pay-at-the-pump capabilities.