Medicare Physician Fee Schedule:

• The 2025 Medicare conversion factor will be $32.35, a 2.83% decrease from $33.29 in 2024
• This reduction is due to budget neutrality requirements and expiration of temporary relief enacted by Congress
• Overall reimbursement for cardiovascular services is projected to remain flat compared to 2024

UnitedHealthcare Changes:

For Medicare Advantage plans, UnitedHealthcare is implementing new prior authorization requirements effective January 1, 2025

Delayed care and preventive services

Deductibles also influence how patients use healthcare services. Patients tend to delay or forgo care, including preventive services, when facing high deductibles. This can lead to more severe health issues down the road, potentially impacting a provider’s ability to deliver timely and effective care.

Financial risks for providers

As patients become responsible for larger portions of their healthcare costs, providers face increased financial risks. They may struggle to collect payments from patients who cannot afford their deductibles, affecting the providers’ revenue stream. Given the potential financial burden of high deductibles, providers may need to offer payment plans to help patients manage their healthcare costs and receive the care they need.

Shift in service utilization patterns

Demand for services tends to slacken across the board during the deductible phase, including both preventive care and expensive tests. This shift can impact providers’ workflow and resource allocation.

Reduced patient visits and demand for services

High deductible health plans reduce overall employee health care spending by 12-14% annually, primarily due to patients reducing their demand for services. This decrease in utilization affects providers’ patient volume and revenue, especially early in the year when deductibles reset.  For example, if a patient has a $5,000 deductible, they will need to pay the first $5,000 of covered medical expenses before their insurance starts paying.

Delayed care and preventive services

Deductibles also influence how patients use healthcare services. Patients tend to delay or forgo care, including preventive services, when facing high deductibles. This can lead to more severe health issues down the road, potentially impacting a provider’s ability to deliver timely and effective care.

Get Paid and Send Reminders

Make sure you have no unpaid invoices waiting to be sent out. If you do, don’t wait any longer. If you have insurance companies or patients who haven’t paid their invoices yet, begin the follow-up process right away.

Record All Expenses

Close out your practice’s financial year by making sure you’ve properly recorded and updated all your income and expenses. Falling behind on recording or categorizing expenses can make the new year messier than it needs to be and can lead to undesirable surprises down the line. 

Properly recording all expenses in your accounting software will keep your numbers accurate. It’ll also help your CPA find all your tax-deductible expenses easily when they assist you.

Pay Any Outstanding Invoices

While making sure your practice is receiving payments, you should also confirm that all your unpaid vendor debts, bills and employee payments are squared away before the new year.

Consider Annual Bonuses

A bonus not only shows your appreciation for your hardworking employees but also boosts morale going into the new year. Additionally, if you pay out your annual bonuses before December 31, the IRS considers them a deductible expense which will lower your taxable income. 

Purchase Medical and Office Equipment

If you’ve been eyeing some new medical or office equipment for your healthcare practice, now might be the time to buy. Purchasing qualifying equipment and implementing it before the end of the year can allow you to expense the cost up to a certain amount. 

Plus, end-of-the-year sales make it easy to find just the right price for your clinic.

Current Challenges

Inadequate Coverage – Many Americans still lack comprehensive health insurance coverage, leading to increased medical debt and poorer health outcomes. The uninsured and underinsured often delay seeking care until their conditions worsen, resulting in higher costs and negative health outcomes.