After speaking with Ulrich Brechbühl, President and CEO of Chamberlin Edmonds, earlier this summer about how his firm helps connect underserved patients with the most appropriate government healthcare programs, (See “Connecting Patients with Care, and Hospitals with Profit”) I was eager to hear the hospital’s side of the story. Just how big of a benefit were these services bringing to patients’ lives?
Cathy Dougherty, Associate Vice President of Revenue Management at Gwinnett Medical Center, was happy to share details – and one very compelling patient success story – about the impact Chamberlin Edmonds’ services have had on the hospital’s patients. The not-for-profit healthcare system comprises two hospitals, numerous medical facilities, more than 4,000 employees and 800 physicians. I was especially interested in hearing about Gwinnett Medical’s experience in particular, having spent my high-school years in Gwinnett County, just outside of Atlanta.
Gwinnett Medical has worked with Chamberlin Edmonds for more than 15 years. According to Dougherty, the company screens patients for such Federal healthcare programs as:
* social security disability insurance benefits
* social security supplemental security income
* Medicare
* end stage renal disease
State programs include:
* aged, blind and disabled
* 3 MP to SSI
* emergency Medicaid assistance
* adult medically needy
* low-income Medicaid
* Right from the Start Medicaid
* breast and cervical cancer program
* crime victim compensation program
I asked Dougherty to share a patient “success” story, and her opinion on how firms like Chamberlin Edmonds will assist hospitals in dealing with the influx of patients that are predicted (at this point, anyway) to enter the healthcare system in 2014.
Can you give me an example of how Gwinnett Medical patients have benefited from on-site eligibility screening services?
Certainly, though we’ve changed identifying details to protect the patient’s privacy.
Mr. Leroy is a 69- year-old single man who was admitted to Gwinnett Medical Center for lower abdominal pain. He has never been able to take proper care of his health, and has worked since 1983 as a handyman at a hotel. Prior to his admission, he was making only $100 per week, living on-site at the place of his employment, and had no other assets such as a car or property in his name. He was not receiving any government or state benefits.
Upon admission, doctors discovered that Mr. Leroy had cellulites, sinus syndrome, stage three chronic kidney disease, a hernia and atrial fibrillation. Due to his age and medical condition, he had not been able to perform the same degree of work at his job over the last several months. He mentioned he had felt sick for some time but, due to limited resources and income, never pursued medical treatment. In spite of his health problems, he was still working part time just to survive — he had no other support to help him make ends meet.
While Mr. Leroy was at Gwinnett Medical Center, he was screened by a Chamberlin Edmonds representative. He met the criteria for SSI and disability benefits, but also appeared to be eligible for additional programs. After completing an application and working with the Social Security Administration, the eligibility specialist working with Mr. Leroy was able to assist him in securing ongoing medical coverage, as well as retroactive benefits that provided him with a lump sum check (for back payments) of $8,000.
Will GMC consider adding Chamberlin Edmonds representatives to handle the predicted influx of patients in 2014 – many of whom will likely be eligible for Medicaid?
Yes. We do not anticipate any issue with a volume influx, as Chamberlin Edmonds has always staffed our account according to volume. Additionally, our system will be a new provider of open heart surgery services in January 2012. This will bring additional growth for us, and we’ll be ready to serve those patients needing eligibility and enrollment assistance.
What do you predict will be the biggest financial challenges hospitals will face in the next few years as healthcare reform steams ahead, more patients enter the payment system, and providers adopt new care models?
The “unknown” is hard for our system to plan for. We continue to learn of new impact from healthcare reform that are coming into play now and in the future, but there is no certainty regarding the effects of these provisions. The financial impact of healthcare reform and Medicare and Medicaid payment reductions continue to be of concern and high on our radar screen. In addition, the implementation of the ICD-10 diagnosis and procedural coding system from the current ICD-9 system will be a significant expense — presenting hospitals with financial risk.
Jennifer Dennard is Social Marketing Director for Atlanta-based Billian's HealthDATA and Porter Research.