Patching Holes in the Safety Net
Technically, we’ve emerged from the Great Recession, economists say. However, the reality is—as so many healthcare organizations know—that casualties from the economic downturn continue to pile up.
A recent article in the Star Tribune newspaper detailed how Minnesota’s largest public hospital, the Hennepin County Medical Center, will deny nonemergency care to uninsured nonresidents beginning January 1, 2011, to reduce its bad debt exposure. The decision handed down by the medical center’s board is expected to help save the facility about $600,000 annually.
Unfortunately, this is hardly an isolated case. While many organizations want so selflessly to help those in need, financial realities may make this difficult, if not impossible, to accomplish. Hospitals around the country serving poorer communities are now charging nonresidents ED fees or, in some cases, appealing to state and local bodies for financial assistance to offset mounting debts.
As the last hope for many of those without health insurance, emergency departments continue to drain on hospitals’ financials. According to a study recently published in the Journal of the American Medical Association, the number of safety net institutions—defined as those that provide more than 30 percent of total ED visits to uninsured or Medicaid patients (or greater than 40 percent of visits by a combination of the two) for the purposes of the report—increased by 41 percent between 2000 and 2007.
But what about healthcare reform, which is supposed to provide healthcare coverage to these individuals in the next few years? Unfortunately, it may not be a cure-all for safety net hospitals—at least not within the near future—and changes to legislation may actually complicate matters.
Legislative changes are outside of the control of safety nets, but there are steps their leadership can take to help ease the burden of uncompensated care. Among them, hospitals can work to secure financial assistance for uninsured or underinsured patients. Increasingly thorough and intuitive eligibility services are the conduit through which additional funding sources can flow.
For example, many institutions are now filtering self-pay cases through eligibility screening software in an effort to identify patients who may qualify for—or may have—Medicare, Medicaid or another coverage program even if they did not indicate as much at admission. Additionally, hospital staff is qualifying patients for charity care upfront, or working out reasonable financing plans for self-pay individuals.
By focusing on eligibility and enrollment services, hospitals can significantly lower their rate of undetected coverage and receive reimbursement for care that may have otherwise been written off as bad debt.
Whether it’s helping low-income individuals apply for benefits assistance through Medicaid, Supplemental Security Income (SSI) or other programs, reform- and recession-proof eligibility services are allowing hospitals to continue providing care to all.
Ulrich Brechbühl serves as the President and Chief Executive Officer of Chamberlin Edmonds. Chamberlin Edmonds is a provider of comprehensive eligibility services for hospitals, government agencies, and managed care organizations.
