Study findings highlight financial impact underinsured have on healthcare providers, including clinical laboratories and pathology groups
Commonwealth Fund’s 2024 Biennial Health Survey released in November shows that not only are Americans underinsured, but many are swimming in medical debt. This is not good news for clinical laboratories. Simply put, labs must collect deductibles, copays, and out of pocket amounts from insured patients. If the patient is underinsured, that means the lab probably has to collect more—even 100%—of total charges directly from the patient.
The study conducted between March and June of 2024 collected data from 8,201 respondents ages 18-64, and despite two of every three respondents carrying health insurance through their employers, one of every four is underinsured, according to a Commonwealth Fund news release.
A further 44% of respondents have medical debt, with one of every four calling their out-of-pocket payments “nearly unaffordable,” the news release notes. Additionally, one out of five had a gap in coverage during the year.
“Congress, employers, insurers, and healthcare providers all play a role in lowering costs and making care more affordable, so families can avoid debt and get the care they need to stay healthy,” said Sara R. Collins, PhD, lead study author and Commonwealth Fund Senior Scholar and Vice President for Health Care Coverage and Access and Tracking Health System Performance, in the news release.
Astute laboratory managers will look beyond the study’s face value and consider the profound impact such findings could have on their own labs.
“While having health insurance is always better than not having it, the findings challenge the implicit assumption that health insurance in the United States buys affordable access to care,” the Commonwealth Fund said of its 2023 study. This sentiment rings true in the Funds’ latest findings as well.
“The Affordable Care Act has covered 23 million people and cut the uninsured rate in half. But high costs are a serious problem for many Americans, regardless of the kind of insurance they have,” said Sara R. Collins, PhD (above), lead study author and Commonwealth Fund Senior Scholar and Vice President for Health Care Coverage and Access and Tracking Health System Performance, in a news release. Clinical laboratories and anatomic pathology groups are greatly affected by underinsured patients. (Photo copyright: Commonwealth Fund.)
Labs Often Must Collect Payments Upfront
Many patients are in high deductible health plans and may forgo or delay ordered lab tests. Labs collect patient deductibles, copays, and out-of-pocket expenses directly from patients. However, underinsured patients may be required to pay for 100% of the services they receive, requiring the lab to collect these payments upfront.
Underinsured patients already facing a mountain of debt may struggle to pay for lab services. The debt many owe is substantial. “Nearly half (48%) of all adults with medical debt owe $2,000 or more; one of five (21%) carry a staggering $5,000 or more in debt,” Commonwealth Fund noted in its study.
Thus, collecting money owed is proving to be a problem for healthcare providers. Patient collection rates are plummeting to 48%, with “providers writing off more bad debt from patients with insurance,” TechTarget reported.
“Lower patient collection rates left providers facing bad debt. The analysis showed that 1.54% was the bad debt write-offs as a percentage of total claim charges in 2023. Researchers note that the percentage may be small, but the total cash amount equated to over $17.4 billion last year,” TechTarget added.
Having some rather than no insurance is not the safety net for patients previously thought. When it comes to the insured, their debt “accounts for 53% of the estimated $17.4 billion that hospitals, health systems, and medical practices wrote off as bad debts in 2023,” Business Wire noted, citing data from Kodiak Solutions’ quarterly revenue cycle benchmarking report.
Delaying Critical Lab Tests
The challenges the insured face with debt impacts labs in the long run. A staggering 57% of survey respondents reported passing on needed care because they could not afford it, and of those, 41% said their health concerns worsened when they denied themselves that care, Commonwealth Fund noted.
Increasingly poor health means patients might struggle to collect sufficient income to pay for their now added expenses, further causing them to struggle to pay for anything insurance might not cover, such as doctor ordered lab tests.
The affect this has on hospitals and medical laboratories casts light on the healthcare marketplace as a whole. It’s a trend that needs to be further studied.
“Most hospital bad debt is associated with insured patients, and nearly one in three hospitals report over $10M in bad debt,” are two of the top five financial healthcare statistics reported by Definitive Healthcare in a 2023 report.
“Expanding patient collection strategies may be key to maximizing revenue and avoiding losses,” TechTarget suggested.
Possible Solutions
The Commonwealth Fund study made clear that employer-covered healthcare does not guarantee affordable care or that ample care will be provided. Possible solutions from the study called on policymakers to “expand coverage and lower costs for consumers.” It added that “extending enhanced premium tax credits and strengthening protections against medical debt could make coverage more protective and affordable.”
Until a solution can be found, it’s wise to stay abreast of this trend and how it can impact the bottom line of clinical laboratories and anatomic pathology groups nationwide.
Medical laboratories may find opportunities guiding hospital telehealth service physicians in how clinical lab tests are ordered and how the test results are used to select the best therapies
Telehealth is usually thought of as a way for patients in remote settings to access physicians and other caregivers. But now comes a pair of studies that indicate use of telehealth in inpatient settings is outpacing the growth of telehealth for outpatient services.
This is an unexpected development that could give clinical laboratories new opportunities to help improve how physicians in telehealth services use medical laboratory tests to diagnose their patients and select appropriate therapies.
Dual Surveys Compare Inpatient and Outpatient Telehealth
Service Use
Definitive Healthcare (DH) of Framingham, Mass., is an analytics company that provides data on hospitals, physicians, and other healthcare providers, according to the company’s website. A survey conducted by DH found that use of telehealth solutions—such as two-way video webcams and SMS (short message service) text—has increased by inpatient providers from 54% in 2014 to 85% in 2019, a news release stated.
Meanwhile, a second Definitive Healthcare survey suggests
use of telehealth in outpatient physician office settings remained essentially
flat at 44% from 2018 to 2019, according to another news
release.
For the inpatient report, Definitive Healthcare polled 175 c-suite
providers and health
information technology (HIT) directors in hospitals and healthcare systems.
For the outpatient survey, the firm surveyed 270 physicians and outpatient
facilities administrators.
DH’s research was aimed at learning the status of telehealth
adoption, identifying the type of telehealth technology used, and predicting possible
further investments in telehealth technologies.
Most Popular Inpatient Telehealth Technologies
On the inpatient side, 65% of survey respondents said the most used telehealth mode is hub-and-spoke teleconferencing (audio/video communication between sites), Healthcare Dive reported. Also popular:
Fierce
Healthcarereports that the telehealth technologies showing the largest
increase by hospitals and health networks since 2016 are:
Two-way video/webcam between physician and
patient (70%, up from 47%);
Population health management tools, such as SMS
text (19%, up from 12%);
Remote patient monitoring using clinical-grade
devices (14%, up from 8%);
Mobile apps for concierge services (23%, up from
17%).
“Organizations are finding new and creative ways through telehealth to fill gaps in patient care, increase care access, and provide additional services to patient populations outside the walls of their hospital,” Kate Shamsuddin, Definitive Healthcare’s Senior Vice President of Strategy, told Managed Healthcare Executive.
DH believes investments in telehealth will increase at
hospitals as well as physician practices. In fact, 90% of respondents planning
to adopt more telehealth technology indicated they would likely start in the
next 18 months, the news releases state.
Most Popular Outpatient Telehealth Technologies
In the outpatient telehealth survey, 56% of physician
practice respondents indicated patient portals as the
leading telehealth technology, MedCity
News reported. That was followed by:
Hub-and-spoke teleconferencing (42%);
Concierge services (42%);
Clinical- and consumer-grade remote patient
monitoring products (21% and 12%).
While adoption of telehealth technology was flat over the
past year, 68% of physician practices did use two-way video/webcam technology
between physician and patient, which is up from 45% in 2018, Fierce
Healthcare reported.
The graph above, taken from the Definitive Healthcare 2019 survey, shows the percentage of telehealth use among surveyed outpatient settings. “The results show how telehealth continues to be one of the core linchpins for providers,” Kate Shamsuddin, Definitive Healthcare’s Senior Vice President of Strategy, told Healthcare Dive. (Graphic copyright: Definitive Healthcare.)
MedCity News reports that other telehealth technologies in
use at physician practices include:
Mobile apps for concierge service (33%);
Two-way video between physicians (25%);
SMS population management tools (20%).
Telehealth Reimbursement and Interoperability Uncertain
Why do outpatient providers appear slower to adopt
telehealth, even though they generally have more patient encounters than
inpatient facilities and need to reach out further and more often?
Definitive Healthcare reports that 20% of physician practice
respondents are “satisfied with the practice’s current solutions and services,”
and though telehealth reimbursement is improving, 13% are unsure they will be
reimbursed for telehealth services.
The Centers
for Medicare and Medicaid Services (CMS) states that Medicare
Part B covers “certain telehealth services,” and that patients may be
responsible for paying 20% of the Medicare approved amount. CMS also states
that, effective in 2020, Medicare
Advantage plans may “offer more telehealth benefits,” as compared to
traditional Medicare.
“There is not only a need for more clarity around reimbursement policies, but also a need for more interoperable telehealth solutions that can be accessed through electronic health record or electronic medical record systems, as well as a better understanding about what types of telehealth options are available,” said Jason Krantz (above), CEO, Definitive Healthcare, in the outpatient telehealth survey news release. (Photo copyright: Definitive Healthcare.)
The increase in telehealth use at hospitals—as well as its
increased adoption by physician offices—may provide clinical laboratories with opportunities
to assist telehealth doctors with lab test use and ordering. By engaging in telehealth
technology, such as two-way video between physicians, pathologists also may be
able to help with the accuracy of diagnoses and timely and effective patient
care.
