Published in Physicians Practice | February 28, 2016 | By Jeffrey Brunken
Healthcare costs are continuing to rise in spite of the Affordable Care Act (ACA) implementation. For medical-professional liability insurers, these rising costs may be an ominous sign. There is a growing belief that rising healthcare costs may lead to increased liability risks for physicians.
Under the ACA, the health system is suddenly providing care to millions of newly insured Americans. After the most recent enrollment period ended in January, Money magazine reported that 12.7 million Americans re-enrolled or bought a new health insurance plan. Of that number, 42 percent purchased health insurance for the first time. That’s more than 533,000 newly insured Americans.
What happens when those patients show up for their first physician office visit? Most of these patients will deal with sticker shock. Whether it be copays at the point of care, or a high-deductible plan, most health plans are pushing more of the cost to patients. For most patients, out-of-pocket costs are rising. One likely result is that physicians and their front-office staffs will bear the brunt of patient frustration and complaints.
Not only will front-office staff hear complaints, but physicians also may face increased liability risks. In today’s litigious society, when consumers are dissatisfied, it’s not unusual for them to seek some kind of remedy through the courts. Since physicians are the ones asking for payment, they could face lawsuits from patients who are dissatisfied or unable to pay.
What’s more, many patients don’t pay in full during their office visits because they may not know how much they owe or even understand their responsibility to pay. That means someone in the physician’s billing office may need to follow up with these patients to collect what’s owed. Calling patients about outstanding debts is another factor that could increase patients’ dissatisfaction and raise liability risks.
Recently, a survey by The New York Times and the Kaiser Family Foundation showed that some patients were struggling to pay for their healthcare. The survey results demonstrated that even though one in five respondents had health insurance, they still struggled to pay their medical bills in the past year, The Times reported. When they struggled, many skipped getting the care they needed and some took other steps to make ends meet, such as taking a second job or working more hours, using their savings, moving, taking in roommates, or getting help from charities, the newspaper said.
When patients who have not had access to the healthcare system find out that just getting care in a physician’s office is more costly than they might have predicted, it’s likely that their dissatisfaction with their care will rise. And just as when consumers pay for anything out of their own pocket, their expectations rise. Last fall at a healthcare conference, patients’ expectations was one of the issues discussed. Those in attendance were warned that when patients are unhappy and have to pay for their own care, there is an increased chance that this dissatisfaction will lead to a lawsuit. As patients’ first access point to the health care system, physicians may be named as defendants, the speaker added.