In January, the Affordable Care Act (ACA)'s individual mandate will enter the next phase of its roll out. Millions of uninsured Americans will face penalties if they do not enroll in a health plan. Uninsured problem solved, right?
Not so fast, say many experts. It is predicted hospitals will continue to face increasing reimbursement shortfalls from uninsured patients for the next several years.
Why? With penalties as low as $95 for individuals and up to $285 (or 1 percent of family income, whichever is greater) for those not enrolled in health plans versus monthly premiums ranging from $50 to $300 or more, the benefit versus penalty ratio may not be enough to sway millions to enroll. As a result, by 2019 hospitals could incur $53.3 billion more in uncompensated care costs than originally estimated.
In an effort to combat losses, some hospitals have reverted to strategies that could cause a number of problems down the road. These include:
- Not providing education or support to ER patients at the point-of-care. Because of state and federal regulations (AB774 in California, for example), many hospitals inform patients about their eligibility for Medicaid and charity care; however, that is where the effort usually stops. Little is done to educate patients about additional coverage options, such as high-risk pools and cancer assistance programs, and even less is done to follow-through and enroll patients, which will become especially important as the ACA's Health Information Exchanges (HIE) roll out. Patients may choose not to enroll in coverage until it's completely necessary--at the point-of-care when they come into the ER.
- Overlooking lesser-known coverage options. Despite perceptions, there are a number of coverage programs available now to assist uninsured patients. With the recent update to the Federal Poverty Level, even more patients are eligible for these programs, but may not know it. These include county plans and programs for pregnant women or specific diseases. Also, don't forget COBRA, which can cover a patient retroactively for 90 days if elected before the 60-day election period is over.
- Implementing overly aggressive collection techniques. Hospitals are required by law to treat all patients that present to the ER with or without coverage. If uninsured patients do not have a "need treatment now" emergency, some hospitals are hiring third party collection agencies to collect co-payments from these patients prior to treatment. Results have shown these patients will often leave the hospital without being treated because of feeling pressured to pay. If the patient's symptoms lead to a more serious illness, the aftermath is both costly to the patient and to the hospital's reputation. All could have been prevented if the hospital chose to have a conversation about available health coverage options with that patient prior to treatment and requesting a co-pay.
Next Steps
With the onus continuing to be on hospitals to treat the uninsured, hospitals should look for new resources and tools and commit to becoming a trusted resource for uninsured patients.
A first step is to ensure that existing billing and revenue cycle processes include an educational outreach component. The second is to educate ER staff on available coverage options, so that each can confidently and empathetically communicate support to patients at the point-of-care. To help with these two steps, there are eligibility software solutions emerging that allow ER staff to administer short screenings to patients that show all coverage options at the point-of-care.
Establishing a consistent self-pay process that educates patients on coverage options and incorporates HIE enrollment will ensure that hospitals will be able to continue assisting uninsured patients, while also securing reimbursement and improving their bottom line.