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HSA collection strategies: Learning how to ask for payment

As more patients enroll in health savings accounts, physicians might find that they need to adjust their practices to the new business realities of consumer-driven health care.

By Jonathan G. Bethely, amednews staff. May 15, 2006.

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Family physician Donald L. Copeland, MD, of Cornelius, N.C., is spending a lot of time these days talking to younger doctors about how things used to be, like how doctors collected from their patients before the patients left the office. Now that those days appear to be coming back, thanks to the rapid growth of health savings accounts, he's finding some very willing listeners as physicians try to figure out how to adjust to life in a consumer-driven health care environment.

The younger physicians don't have much experience with in-office collection, which is what Dr. Copeland had to do when he started practice in 1965. Of course, they didn't call it "consumer-driven health care" back then. In 1960, a few years before Dr. Copeland started practice, 60% of health care costs were paid directly by patients, out of pocket. Forty years later, with managed care limiting in-office patient payments mostly to co-payments, that number was down to 15%, said Greg Scandlen, director of the Center for Consumer Driven Health Care, part of the pro-market Galen Institute of Alexandria, Va.

Soon enough, Dr. Copeland believes, that percentage will be going up. "Most of their patients will be paying cash," the 72-year-old Dr. Copeland said of his younger colleagues. "They're not near anywhere ready. ... They don't even know what they're charging patients. They don't know what's going on in the business office."

Dr. Copeland does have more than charity in mind when he's talking to doctors. He also wants to start up a network of HSA-accepting physicians called HSA Healthcare Inc. But his belief that now is the time for physicians to get their business practices ready for HSAs is being sounded by different voices throughout health care.