1. Trouble Paying Bills

The Kaiser Family Foundation reported in a recent survey that 28 percent of Americans are having serious problems paying for health care and health insurance. This could lead patients to cancel appointments or not schedule follow-ups. If you spot a trend with a particular patient who is missing necessary follow-ups, try to discern any underlying problems. If costs of visits or co-pays are a problem, discuss the medical need for follow-ups and consider establishing a payment plan.

2. Stretching Prescriptions
Findings from a recent survey by ICR/International Communications Research reveal that more than one out of five Americans, or roughly 13.5 million, who use long-term prescription drugs (including injectables) have taken steps to stretch their medications in the last three months. These steps include reducing dosage and taking agents less often than prescribed. Be sure to talk to your patients about the importance of taking prescription drugs as directed and be prepared to discuss cost-saving options, like generics, samples, and pharmaceutical company assistance programs with those facing financial hardships. The Partnership for Prescription Assistance (www.pparx.org) may be one place to start.

3. Insurance Rates Rising
Because employers are struggling to turn profits, they may be contemplating options to maintain or cut healthcare costs for the coming year. In a Kaiser/HRET survey of nonfederal private and public employers, 35 percent of respondents reported that increasing the amount employees pay for office co-pays or coinsurance is somewhat likely, while 29 percent said it was somewhat likely that they would increase the amount employees pay for deductibles. Practices should update insurance information for every patient at every visit, but in today's rapidly changing landscape, verification of coverage is especially important.

4. Changing Health Plans
A recent survey by the Trusted Choice and the Independent Insurance Agents & Brokers of America indicates that many consumers are choosing to adjust their insurance policies to save more money. The survey found that 39 million households in the US are making changes to their insurance plans, 60 percent of which cited the economy as their reason for doing so. Reduced policy rates often mean increased co-pays and/or restrictions, like the need to referrals. Always verify coverage prior to appointments (see page 32) and advise patients of the amount they'll be asked to pay at check in.

5. Turning to Physician Alternatives
With locations in retail and grocery stores, walk-in clinics have quickly become a stop for individuals with questions or concerns about their health. These clinics provide basic medical services by a nurse practitioner for a low fee. Anecdotal reports suggest that patients are visiting these clinics with increasing frequency as a low-cost alternative to a doctor's office visit. Aside from lower costs, convenience and a lack of wait time for scheduling make these services attractive. Consider any reasonable options that may be available to your practice to make visits more convenient for patients.