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Fall 2012

Approaches to Collecting from Self Pay and High Deductible Patients

Arne Pedersen, MBA, FACMPE
Director of Client Services, ABC

With the ever-rising cost of healthcare, all parties are looking for ways to finance it. From high deductible health plans with savings components to consumer credit tools such as credit cards and loans, the face of healthcare financing is changing. The challenge for anesthesia in this ever-changing world comes back to the physician-patient relationship.

As noted in previous articles “The Benefits of Strategy” from the Winter 2012 issue of The Communique and “Planning for Payor Negotiations” from the Spring 2012 issue of The Communique, high deductible health plans (HDHPs) are a growing health insurance product line. This puts a greater emphasis on collecting larger sums of money from the patient. Moreover, the current economic climate has put a strain on the safety nets that are in place to help those with fewer resources. The self-pay category is growing and the need to address this issue is at the forefront in collecting patient liabilities for anesthesia services rendered. This article will explore the various payment options available today along with some cautions.


One of the criticisms levied against the healthcare industry is the transparency of costs associated with care. The challenge is sharing a reasonable estimate with a patient prior to surgery. In cases when the surgery is an emergency, the ability to discuss pricing tends to take a back seat in the interest of taking care of the patient. However, elective procedures are another story. Medscape conducted an interesting study1 earlier in 2012 that primarily focused on physician compensation across a broad spectrum of specialties including primary care. One of the questions asked referred to discussing the cost of treatment with the patient. As shown in figure 1, only 38% of the respondents regularly discussed the cost of treatment with their patients.

The other interesting note is that 46% of the respondents discuss the cost of treatment if the patient brings it up. The second point is interesting only because of an important driver of the HDHPs was to get the patient actively involved in containing the cost of care. For anesthesia, this is tricky since the relationship with the patient is brief. The ultimate goal for anesthesia is to develop and nurture the relationship with the various facilities to assist in taking advantage of patient payment programs that those facilities might be involved with such as healthcare credit cards or health care loans. This will not apply in all cases. Groups may need to consider other strategies.

Outpatient Surgery magazine online published an informative article earlier this year about the financing of surgeries.2 In it, the author described the various financing options to include the use of healthcare credit cards, healthcare loans, and shared risk approach. These approaches seemed to be more appropriate for ambulatory surgery centers than for hospitals. The author walks through the basics of how to accomplish this and then provides some live examples of the positive impact to the centers.


In further research on these options, creditcards.com3 walks through some of the companies who are offering the credit card options including the use of debit cards in health savings accounts, which are used as part of the HDHPs. There is some concern about patients using revolving credit to pay for procedures. The author spent some time researching the various options; as summarized in Table 1 on the next page.

There is another option called AccessOne Medcard ( As with any of the options presented above, research is a key to better understand these approaches. Again, staying engaged will help groups to explore these options to capture patient liabilities early on in the billing process.

Groups with a robust chronic pain practice may want to look into these approaches. Any one of these approaches may provide a more regular stream of cash flow for the practice. As stated earlier, it is important to do the homework to understand the impact to the patient especially considering this is a more retail environment. While these are certainly laudable approaches to collecting patient liabilities, they are not the only approaches. Groups can look to execute a billing holdback strategy, which holds filing claims for a period of time to allow surgeons and facilities to file theirs earlier. The outcome is that the anesthesia groups collects more from the insurance carrier (payor) providing a more positive impact to the bottom line. This approach focuses on the timing of claims submission. It has proven to work well for multiple ABC clients.

The ultimate decision is up to the group. Each strategy has pros and cons. With a little homework and correct set of expectations, a group can make a solid strategic decision for itself. Be sure to encourage clients with questions to contact Arne!

Arne Pedersen, MBA, FACMPE, serves as Director of Client Services for ABC. He is a Fellow of the American College of Medical Practice Executives. His distinguished background includes serving as a former Anesthesia Group Administrator, an expert on leadership, and a Bronze Star Medal recipient from the Persian Gulf War. Mr. Pedersen authored the book, “Lead with Intent” a comprehensive, yet practical leadership bible with a vision of training leaders. Mr. Pedersen serves an adjunct professor at the University of Notre Dame in the Executive Education Certificate Program and teaching Performance Management.