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Navigating the Patient Experience in an Era of High-Deductible Plans

February 20th, 2019

Donna Nicholson

The recent and steady increase in high-deductible health plans across the U.S. has ushered in a new era of patient expectations—and increased liability—for medical practices and providers. According to the CDC, 43.2 percent of Americans had high-deductible health plans as of Feb. 2018, increasing from 39.4 percent the previous year. Since then, this number has continued to grow, and it’s important for medical practices to be aware of the implications of this increased spending.

During my career as a nurse, I regularly oversaw risk management and quality assurance areas for the practice, and I handled most patient complaints. High-deductible plans became more prevalent during this time, and I noted a major trend that emerged as a result: general patient attitudes and perspectives changed drastically, and patients began to expect more from their interactions with physicians and with practice staff—from scheduling the appointment, to the time in the exam room, to the billing process after the visit.

With these high-deductible plans, patients are paying the first dollar—and they are often paying it to the tune of $5,000 or more. As a result, patients often expect immediate results or cures, and many fail to follow up that first appointment with necessary prescriptions, specialists, or medical tests, due to the significant financial burden. We’ve also noticed a trend of more patients being quick to place blame on doctors when expectations go unmet. As a result, medical practices may experience an increase in medical board complaints and malpractice claims.

To protect themselves and their practices and ensure high-quality service and healthcare for patients, practice leaders should take the following steps:

  1. Educate staff on the importance of providing high-quality customer service and a positive interpersonal experience. Behavior drives claims, and patients who feel they have been treated poorly by office staff, physicians, and medical assistants may be more likely to blame the practice. If a patient should complain, embrace that complaint quickly with empathy and a service recovery strategy. Medical Mutual members are encouraged to use the patient satisfaction and patient complaints toolkits to help their practice effectively manage the patient experience. In addition, members may access the CME-eligible webinar “Promoting Safety, Professionalism, and Patient and Personal Satisfaction” to learn more about patient communication strategies.
  2. Involve patients in the care decision-making process. In addition, physicians should make best efforts to clearly explain the reasoning behind care decisions to help patients understand why additional services may be necessary to their treatment plan.
  3. Protect the financial risk of the practice with clearly defined policies. Practices should outline specific billing policies and ensure that they are read and understood by all patients.
  4. Empathize with patients experiencing financial difficulties. In many situations, it may be difficult or impossible for physicians to provide patients with clear cost expectations. However, when possible, care providers should help patients explore affordable alternative options and solutions, such as cheaper comparable pharmaceuticals and available financial assistance programs. By simply showing they care for patients’ financial well-being, practices can build an invaluable foundation of trust and mutual respect.


For further guidance on this issue, Medical Mutual members are encouraged to reach out to our Claims and Risk Management Departments at 800.662.7917.

Donna Nicholson is Medical Mutual’s Vice President of Risk Management based in Raleigh, NC.


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