Eligibility quiz saves San Diego hospitals $5M in self-pay revenue

With the help of a two-year task force effort with the Foundation for Health Coverage Education (FHCE), Sharp HealthCare in San Diego saved $5 million from self-pay patient reimbursements at four of their busiest emergency departments.

Using a five-question eligibility quiz for patients at the point of care in emergency departments, hospital administrative staff members are able to determine in about 60 seconds if any uninsured patients are eligible but not signed up for available government programs.

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According to Ankeny Minoux, president of FHCE, the eligibility quiz, called the Point-of-Care Hospital ER Survey, started out as a 30-day trial program at Sharp HealthCare hospitals on March 8, 2010.

"Sharp, like many other hospitals, was struggling with uncompensated care costs and self-pay revenue going down. There were people coming into the ED who couldn't afford to pay bills and Sharp was looking for a solution to this. After the trial, it was so successful that it's now become a permanent process in their EDs," said Minoux.

By the end of January this year, Minoux said in the almost two years since the survey was put into use, a total of 28,163 uninsured patients had participated in the survey. It was found that 80.5 percent of patients were eligible for various public health coverage programs, including joint federal/state programs, Medi-Cal and Healthy Families (California's Medicaid and CHIP programs) and many others. Also, 16.5 percent were eligible for private coverage, including COBRA, and 2.9 percent were eligible for high-risk pool coverage, which includes California's Major Risk Medical Insurance Program.

Minoux said there are many other additional perks to using the quiz as well.

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"For hospitals, we've been able to make it possible to integrate the survey results and coverage options directly into patients' electronic medical records. Patients can follow up on the results and its all right there," she said. "It's not just focusing on the programs that can reimburse retroactively, which a lot of companies do, but its also focusing on future programs that may be available next time for patients."

The eligibility quiz has also changed the dynamic of conversations between hospital administrative staff members and patients, said Minoux.

"Not only has the use of this quiz increased self-pay revenue at the hospitals but we've found that it's a new type of way to communicate with patients. Now when someone comes in that is uninsured, they can immediately find out what their other options are. Patients are more likely to work with the hospital and make payments towards their bills knowing that the hospital has searched for options for them," she said. "This could absolutely help hospital networks, especially if they are struggling with uncompensated care or low self-pay revenue."

To learn more about the eligibility quiz or FHCE, visit www.coverageforall.org.

Follow HFN Associate Editor Kelsey Brimmer on Twitter @kbrimmerhfn.

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