Piedmont Healthcare is requiring patients who shoulder the entire cost of a non-emergency medical service to pay 25 percent of the bill before they get the care.

The system’s new upfront-payment policy was publicly revealed recently at the Healthcare Financial Management Association conference in Orlando. It was first reported by Modern Healthcare.

The patients who will face the new charge fall into two categories: those who are uninsured and pay for their own care, and those who have insurance with high deductibles.

Piedmont, a fast-growing nonprofit, operates 11 hospitals in Georgia.

A Piedmont executive told GHN on Friday that the pay-upfront policy has existed at certain facilities for a couple of years, but now is system-wide.

“We have plenty of room for exceptions [to the policy] based on patients’ circumstances,’’ said Matt Gove, Piedmont’s chief consumer officer. Uninsured patients automatically get a 70 percent discount, he said. “We have very robust financial aid for patients who don’t have the ability to pay.’’

The health system’s $250.7 million bad-debt expense in fiscal 2018 was about 8 percent of its $3 billion in revenue that year — up from 6.5 percent of revenue the prior year and much higher than the 2 percent national average that the American Hospital Directory calculated in 2017, Modern Healthcare reported.

“We’ve seen patient liability grow significantly over the past three years,’’ said Gove, citing the increase of high-deductible insurance policies.

The growth of those health plans – which trade lower premiums for higher deductibles – often creates situations in which patients have difficulty paying for medical services and hospitals struggle to collect unpaid bills.

Among the 156 million Americans with health insurance through employers, 1 in 5 have deductibles of more than $3,000 for individuals and $5,000 for families, according to a May survey by the Kaiser Family Foundation.

A Kaiser Foundation poll this month found that one-third of insured adults say it is either “very difficult” or “somewhat difficult” for them to pay their deductible.

Medical bills are an overwhelming problem for many families. The KFF poll found about one-fourth of U.S. adults say they or a household member have had problems paying medical bills in the past year, and about half of this group (12 percent of all Americans) say the bills had a major impact on their family.

Nonprofit hospitals’ bad debt, meanwhile, is expected to increase by 8 percent to 9 percent this year as health care plans place a greater financial burden on patients, according to Moody’s Investors Service.

The pay-upfront policy is often used by physicians’ offices, according to industry experts, who add that Piedmont may be the first system in Georgia to have a system-wide policy for hospital services.

Berneta Haynes of the consumer advocacy group Georgia Watch said Piedmont’s pay-upfront policy “raises red flags’’ as a potential barrier for patients seeking medical care.

The policy could deter some patients, forcing the uninsured and those with high deductibles to seek care elsewhere, she said.

For the insured, their hospital networks ‘‘can be so narrow that going to another hospital may not be feasible,’’ Haynes said.

Deductibles have soared, she said, because the Affordable Care Act’s rules on them have been weakened.

Haynes said Georgia Watch wants to make sure that patients are made aware of discounts that are available and that nonprofit hospitals inform patients of their financial assistance programs, which are required under the ACA. She said Piedmont’s providing that help will be crucial for many patients.

(Here’s a link to Georgia Watch’s guide for consumers on medical bills.)

Gove said health systems like Piedmont operate on very thin financial margins.

“We believe that asking our patients to pay a portion upfront for non-emergency care is a reasonable approach,’’ he said. “And based on our initial feedback from our patients, [they believe] it is reasonable.”

Chris Kane, a consultant with Progressive Healthcare, said Friday that the Piedmont move “is consistent with trends in revenue cycle management and will likely be adopted by other health systems.’’

Health systems nationwide have been more aggressive with front-end collections, Kane said. When a successful health system may have only a 5 percent operating margin, it is appropriate to evaluate opportunities to enhance collections and therefore cash flows, he said.

Other systems “will watch Piedmont to discern if the policy has improved collections and/or alienated some patients,’’ Kane said.

“Looking ahead, employers are reluctant to continue to raise deductibles and/or premium payments, resulting in higher burdens for employees,’’ he said. “This tactic is not sustainable. Hospitals and physician groups are left to collect the patient portion.”

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