Health Savings Accounts (HSAs) are on the rise in the United States. According to a fact sheet from the White House this month, “The number of Americans with HSAs has tripled from one million in March 2005 to the more than three million reported in January 2006. The number of Americans with HSAs is currently projected to increase to 29 million by 2010.” These accounts consist of a contribution made by an employer to an employee’s tax-free savings account. The HSA is combined with a high-deductible insurance policy ($1,000 to $5,000) to help people pay pre-deductible expenses.
People with HSAs love the accounts because they can use the money in their account for over-the-counter medications, massage therapy, lasik eye surgery, and other “elective” medical procedures. When a real emergency does arise, however, HSA account holders often find their account under-funded and have trouble paying their medical bills.
Because payment in the HSA scenario is the responsibility of the patient and not the patient’s insurance company, providers of all types need to get in the habit of collecting from the patient at the time the service is rendered —or even before it is rendered (in the case of routine procedures with predictable costs). The days of billing patients in the weeks following a procedure are coming to an end. Unlike post-service claims with health insurance companies, patients are far less likely to respond to an after-the-fact bill.
The upside to collecting for patients with HSA accounts at the time of service is that most HSA account holders have a debit card connected directly to their account which they can use to pay their medical provider. Therefore, if they have the money in their account, they will usually be amenable to paying at the time of service.
The HSA insurance model creates new payment for pathology group practices, because there is no direct contact with the patient. So how can a pathology practice prepare to deal with patients covered by HSA insurance plans? First, when HSA patients come into a patient service center to provide specimens, it is a good proactive measure to notify them in writing that they will be responsible for payment at the time the tests are done. Second, office staff must be trained to know the different types of insurance policies and to know that HSA patients must provide payment at the time of the test. They should have the knowledge needed to help HSA account holders realize that they can use their HSA debit card to pay.
Finally, both clinical laboratories and pathology groups must be prepared to deal with the new type of patient-consumer that has an HSA account. These patient-consumers will look at medical services like retail commodities. They will balance cost and quality in making a decision on which medical facility, laboratory, or physician to use. For this reason, laboratories must develop patient-friendly price schedules for all laboratory services. These should be competitive with the cost of services offered at comparable laboratories. HSA-insured patients are likely to seek out laboratories with prices that match or beat competitor’s prices. Adapting to HSA account holders will require a significant effort by laboratories. However, the drastic reduction in lag time between services rendered and payment received lower the patient default rate. In the long run, that should make laboratories more profitable.