American College of Emergency Physicians s1
Resolution 17(16) Insurance Collection of Beneficiary Deductibles
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Resolution 17(16) Insurance Collection of Beneficiary Deductibles
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RESOLUTION: 17(16)
SUBMITTED BY: Connecticut College of Emergency Physicians
Daniel Freess, MD, FACEP
Greg Shangold, MD, FACEP
SUBJECT: Insurance Collection of Beneficiary Deductibles
PURPOSE: Advocate for health insurance companies to provide full payment to physicians and leave collection of beneficiary deductibles to insurance companies. Submit a resolution to the AMA seeking same policy at the national level.
FISCAL IMPACT: Unbudgeted staff and consultant resources to convey ACEP position to federal and state lawmakers and regulators in favor of insurance company mandate to collect deductibles directly from patients.
Resolution 17(16) Insurance Collection of Beneficiary Deductibles
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WHEREAS, Health insurance is a contract between a health insurance company and a patient; and
WHEREAS, Health insurance companies and employers have created insurance products with increased deductibles to lower premium costs and transfer health care risk and cost to patients and physicians; and
WHEREAS, High deductible health care plans have increased dramatically over the past 5 years; and
WHEREAS, Physicians collect less revenue from charges allocated towards deductibles compared to plans without deductibles; therefore be it
RESOLVED, That ACEP add to its legislative agenda as a priority to advocate for health care insurance companies to be required to collect patient’s deductibles after the insurance company pays the physician the full negotiated rate; and be it further
RESOLVED, That ACEP submit a resolution to the American Medical Association House of Delegates that advocates for a national law requiring health care insurance companies to collect patient’s deductibles after the insurance company pays the physician the full negotiated rate.
Resolution 17(16) Insurance Collection of Beneficiary Deductibles
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Background
This resolution asks ACEP to advocate for health insurance companies to provide full payment to physicians and leave collection of beneficiary deductibles to insurance companies and to submit resolution to the AMA seeking same policy at the national level.
Studies have shown that consumers exercise greater caution in spending when health plans require them to share more of the costs.1 These findings, in conjunction with the enactment of the “Patient Protection and Affordable Care Act” in 2010, have accelerated the use and expansion of high-deductible health plans and additional beneficiary cost-sharing requirements.
In addition to any required premium contributions, most covered workers face cost-sharing for the medical services they use. Cost-sharing for medical services can take a variety of forms, including co-payments (fixed dollar amounts), deductibles (an amount that must be paid before most services are covered by the plan), and/or co-insurance (a percentage of the charge for services). The type and level of cost-sharing often vary by the type of plan in which a beneficiary is enrolled. Cost sharing may also vary by the type of service, such as office visits, hospitalizations or prescription drugs.
Deductibles are the most visible element of an insurance plan to patients, which may help explain why consumers are showing concern about their out-of-pocket costs for care. Although health insurance coverage continues to pay a large share of the cost of covered benefits, patients are generally paying a greater share of their medical expenses out-of-pocket. And, while health care spending has been growing at fairly modest rates in recent years, the growth in out-of-pocket costs comes at a time when wages have been largely stagnant.
The relatively high growth in payments toward deductibles is evident in the changes over time in the distribution of cost-sharing payments: deductibles accounted for 24% of cost-sharing payments in 2004, rising to 47% in 2014. Conversely, co-payments that accounted for nearly half of cost-sharing payments in 2004 fell to 20% in 2014.2
In addition to plans expanding the use of deductibles, they are also increasing the threshold amount of those deductibles. The percentage of covered workers with a general annual deductible of $1,000 or more for single coverage grew from 27% to 46% between 2010 and 2015 and 19% of these plans have an annual deductible of $2,000 or more.3
As patients bear more and more of the responsibility for covering out-of-pocket expenses, health care providers will be increasingly challenged to collect reimbursement for their services.
1 RAND Corporation; "Flattening the Trajectory of Health Care Spending: Insights from RAND Health Research;" Arthur L. Kellerman, Mary E. Vaiana, Peter S. Hussey, Ramya Chari, David Lowsky, Andrew W. Mulcahy; 2012
2 Peterson-Kaiser Health System Tracker: Measuring The Performance Of The U.S. Health System; "Payments for cost sharing increasing rapidly over time;" Gary Claxton, Larry Levitt, Michelle Long; Kaiser Family Foundation; April 12, 2016
3 Kaiser Family Foundation and Health Research & Educational Trust; Employer Health Benefits 2015 Annual Survey; Exhibit 7.8: Percentage of Covered Workers Enrolled in a Plan with a High General Annual Deductible for Single Coverage, by Firm Size, 2015
ACEP Strategic Plan Reference
Goal 1 – Reform and Improve the Delivery System for Acute Care
Objective C – Pursue strategies for fair payment and practice sustainability to ensure patient access to care.
Fiscal Impact
Unbudgeted staff and consultant time and resources to convey ACEP position to federal and state lawmakers and regulators in favor of insurance company mandate to collect deductibles directly from patients. The total cost is difficult to predict.
Prior Council Action
None
Prior Board Action
April 2016, approved the revised policy statement, “Fair Payment for Emergency Department Services;” originally approved April 2009.
Background Information Prepared by: Brad Gruehn
Congressional Affairs Director
Reviewed by: James Cusick, MD, FACEP, Speaker
John McManus, MD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director