To survive, hospital executives must find new and creative ways to help uninsured and low-income patients secure health insurance.
For healthcare systems, uncompensated care has been a pressing issue for decades. Since the Affordable Care Act (ACA) went into effect, the uninsured rate went from 17.1 percent in October 2013 to 12.9 percent in January 2015. It’s a step in the right direction; however, there are 40 million Americans still uninsured.
Plus, with unreliable federal funds, hospitals are often left to absorb the majority of these uncompensated care costs. Consider the current situation in Florida, where the possible elimination of low-income pool funds could leave several hospitals with an enormous budget deficit. The move, which some analysts see as a way for the government to force Medicaid expansion, would mean that many hospitals would be left to care for uninsured patients without sufficient funds to do so.
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With potential budget shortfalls looming in other states, hospital executives are exploring new approaches to helping patients find coverage options.
Here are five of them:
1. Provide patient access to "navigators." A navigator, as defined by ACA guidelines, is a professional who is trained to help individuals look for and enroll in healthcare plans from the marketplace. By enlisting the help of navigators, hospitals help uninsured patients in a clinic or ER enroll in health insurance at no cost to the institution. Because federal funds help pay for a navigator’s service, this option can be attractive to hospitals.
For patients looking for healthcare counsel, however, there is a downside. Navigators aren’t legally allowed to provide advice or rationale on the benefits of one plan over another. For example, if a patient selects a plan based on affordability, but does not realize that his new plan excludes a preferred hospital, the navigator is not allowed to point this out
Another potential problem with employing a navigator is that there aren’t many of them. In Tennessee alone, for example, there are 23 navigators (15 through Seedco and eight through Tennessee Primary Care Association) for more than 800,000 people uninsured. With limited funding, other states have similar statistics. To make a bigger impact on the issue of uninsured patients and uncompensated claims, the number of available navigators needs to dramatically increase.
2. Use a Medicaid verification vendor. A Medicaid verification vendor allows hospital administrations to look up a patient’s Medicaid eligibility in real-time. These third-party vendors often provide a combination of on-site and remote support, and can provide such information as service restrictions and additional insurance resources for each patient. Eligible low-income individuals would have the ability to enroll in Medicaid instantly through such a vendor.
In general, Medicaid vendors are most helpful when dealing with patients that have straightforward, uncomplicated applications. Eligibility requirements for federally funded programs can be confusing and complex. Once other factors are added in, it may be difficult to automatically determine if someone is the right fit for a program.
3. Partner with in-house, non-commissioned advisers. Unlike “navigators,” these advisors are legally able to offer advice on the best available option as patients enroll in new coverage. When appropriate, they help patients navigate through network restrictions, out-of-pocket costs, and issues with current plans. Because these advisers are non-commissioned, they are able to answer questions, offer counsel, and help patients navigate any confusion surrounding healthcare.
Advisers have helped hospitals save thousands on uncompensated care costs. After hiring two such advisers in 2014, one Kentucky hospital enrolled more than 800 patients in new health insurance coverage during the first 12 months. Similar success was found with a Tennessee hospital that placed one adviser on-site in the ER. During her first month, the adviser found an affordable healthcare option for a repeat patient that frequently came to the hospital for care. Instead of sending the patient’s unpaid bills to a collection agency, as it had in the past, the hospital was able to start submitting thousands of dollars in medicals bills to the patient’s new insurance company.
4. Employ existing staff as Certified Application Counselors (CACs). Many hospitals have asked employees to take online classes and pass an exam to become CACs. Usually, these are employees whose primary responsibilities are in registration or financial counseling. This approach has advantages over relying on navigators.
Most obviously, the hospital can make sure a CAC is available on-site to help patients when they need it most. One big disadvantage is that CACs are subject to the same restrictions applied to navigators in that they can’t help people compare insurance options or recommend plans.
5. Do nothing. Every hospital has the option to do nothing, but it’s a choice that’s ill advised. Not implementing programs like the ones above could leave hospitals responsible for the full cost of treating low-income or uninsured patients. For smaller institutions, absorbing these exuberant costs would mean closing.
To survive, hospital executives must continue to find new and creative ways to meet the challenges associated with treating uninsured and low-income patients.
Ryan McCostlin is a team member at Bernard Health, a company that provides non-commissioned, expert advice on health, Medicare and COBRA insurance and medical bill consulting.