A new study from the Healthcare Financial Management Association (HFMA) – “Self Pay and the Benefits of Prospective PatientEngagement” – finds that more patients are paying healthcare providers themselves. The study shows that self-pay has “increased by 10 percent during the last five years,” as high-deductible health plans (HDHPs) have become more common. 

HFMA highlights the following findings from the study’s respondents:

  • Patient payment is rising, with hospitals seeing a 10% increase in self-pay dollars during the past five years.
  • More hospitals have mandatory pre- or point-of-service collections processes for outpatient services, with that number rising from 9% of hospitals in 2009 to 32% in 2015.
  • About 20% of respondents indicated “high capabilities for pricing and patient education related to billing and administrative expectations,” showing there’s plenty of room for hospitals to educate patients more about this topic.
  • About 17% of respondents indicated “high capabilities for pre-service automation, forecasting, and prioritizing financially eligible patient accounts."
  • When it comes to engaging patients about paying for their health care, respondents rated pre-service pricing as the most important priority.
  • When it comes to engaging patients about paying for their health care, respondents rated pre-service pricing as the most important priority.

In addition to highlighting the impact of changing self-pay practices on healthcare providers, the HFMA study also notes that the recent rise of high-deductible health plans (HDHPs) makes payment more challenging for some patients. The study highlights that 25% of adults with health insurance still aren’t sure if they can afford to pay for major medical expenses. This is especially true for adults with HDHPs, and such individuals are “more likely to think about costs when making healthcare decisions” and “are especially likely to worry about the effects of healthcare costs of personal finances.”

The concern about patients having the ability to pay their medical expenses affects healthcare providers as well. HFMA points out that “Medicaid expansion, HDHP trends, and healthcare provider organizations’ adoption of improved charity care identification processes and pre- and point-of-care financial discussions are likely to impact future trends in bad debt,” and that today “the rate of bad debt is increasing at well over 30% per year” in some hospitals.

insideARM Perspective

This HFMA study points various ways that the relationship between patients and their medical expenses is changing due to the increased prevalence of HDHPs. Communicating with patients is key – both about the expenses associated with a medical procedure and the expectations about how and when patients should pay for their care.

HFMA also included numerous instructive “Focus Areas for Self-Pay Process Improvement” that healthcare providers should consider when determining their self-pay policies and procedures, such as:

  • Use patient-friendly communications and consistent messaging.
  • Give patients access to payment estimates at or before time of care.
  • Engage with patients early about issues and options when it comes to paying the bill.
  • Ensure patients have access to financial counseling.
  • Learn, benchmark, and share best practices.


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