Safety net providers struggling with an increase in the uninsured are looking for creative ways to shore up their margins, according to a study released Tuesday by the Center for Studying Health System Change and published in Health Affairs.
"Safety-net providers really are caught in the competitive crossfire of an increasingly profit-driven healthcare marketplace," said HSC Senior Fellow Peter Cunningham, lead author of the study. "They have to maintain their margins to meet their mission of providing care regardless of patients' ability to pay, but some of the steps they are taking to maintain their margins can threaten their mission."
Cunningham, along with HSC consulting researchers Gloria Bazzoli from Virginia Commonwealth University and Aaron Katz from the University of Washington, studied HSC's 2007 site visits to 12 nationally representative communities. The communities are Boston, Cleveland, Greenville, S.C., Indianapolis, Lansing, Mich., Little Rock, Ark., Miami, northern New Jersey, Orange County, Calif., Phoenix, Seattle and Syracuse, N.Y.
HSC has been tracking change in these markets since 1995.
"Our findings are similar to previous studies in that safety-net providers continue to experience financial pressures in part as a result of increasing numbers of uninsured people," the researchers said. "However, some providers are responding in ways that we have not observed previously. These responses include actions to limit their exposure to indigent care, as well as actions that often mimic non-safety-net providers' efforts to increase revenue and attract a more favorable patient mix."
Among the different methods that safety net providers used to protect their bottom lines are:
- Restricting non-emergency care for uninsured living outside the area;
- Applying sliding-fee schedules;
- Collecting out-of-pocket payments from uninsured patients more aggressively;
- Offering discounts to patients who pay up front;
- Upgrading or expanding facilities to attract more privately insured patients;
- And competing for the most profitable services and patients.
What ways are you shoring up your bottom line? Send comments to Senior Editor Diana Manos at diana.manos@medtechpublishing.com.