Those of us who thought the healthcare reform debate would settle once the law was passed and regulations began to take effect may have been misguided. Arguments surrounding reform law and the logistics of its implementation continue to remain in the spotlight. Complete repeal or significant changes to healthcare reform are unlikely in the near term. However, it is probable that there will be tweaks to the law between now and 2014 when the bulk of the statutory provisions take effect.
It is easy for providers to become complacent because so many other changes in healthcare policy have been altered—such as the extension on the looming ICD-10 transition and loosening of requirements for stages two and three of Meaningful Use. But a wait-and-see approach may backfire, especially when confronting changes such as the expansion of state Medicaid programs in 2014.
CMS estimates that, six years after the implementation of Medicaid expansion, 25 million additional Americans will be enrolled in the program, raising the total number to 70 million. Many of these people will be low-income, childless adults with health conditions distinct from the traditional Medicaid population. The onslaught of new eligibles will place a significant strain on hospital administrative and clinical resources. The time to prepare for this eventuality is now.
While it’s hard to believe, the reality is that countless numbers of self-pay patients accumulate medical bills they can’t afford simply because neither patients nor hospitals are aware of the financial assistance programs available to them. Because of the complicated application process for Medicaid and Social Security Disability Insurance, for example, hospitals do not have the resources and/or expertise to simultaneously screen and complete applications for qualifying patients – much less follow up on those applications. But with a steadily increasing self-pay patient load, often resulting in uncompensated care, hospitals and health systems must find a solution to this problem.
The good news is that, in 2014, medical assistance will be available to a substantially larger segment of the population thereby providing relief to providers burdened by unsustainable levels of uncompensated care. The bad news is that the administrative burden of accessing that assistance will be significant.
Hospitals and clinics must be ready to take full advantage of the enhanced availability of Medicaid assistance to individuals who formerly would have been charity or uncompensated accounts. Providers must equip themselves to effectively manage the eligibility process through hiring more internal resources, engaging an eligibility vendor or, where available, financially supporting the placement of agency workers at a facility.
Kirk Reid is the executive vice president and chief marketing officer of Chamberlin Edmonds, an Emdeon company, and a leading provider of healthcare payment and revenue cycle management solutions.