How hospitals can help themselves with Affordable Care Act

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While employers in Pennsylvania are bracing for the expected impact of the Patient Protection and Affordable Care Act on health insurance premiums, the long-range theory behind the act is that the costs will eventually stabilize over time.

This stabilization in employer premiums can be expedited if hospital emergency rooms, which will be affected most by the increase in patient volume, can be proactive in their efforts to educate patients on new coverage options and eligibility.

While the PPACA is slated to insure an added 30 million Americans by 2019, it seems little to date is in place to inform consumers about the new options. And even though Pennsylvania’s new health insurance exchange will go live in October, experts predict that continued lack of awareness and confusion about options will hamper individual enrollment.

Nowhere does this cause greater consternation then at the point-of-care in hospital ERs as they lose billions of dollars each year largely because of unpaid ER bills. If the uninsured don’t get signed up, continued cost shifting will take place and employers will indirectly end up paying for these uninsured patients with higher group health premiums.

In Pennsylvania, 11 percent of its 12.6 million residents are uninsured, many of whom will be positively impacted by the PPACA. And because many will become newly-eligible for Medicaid and private coverage, hospitals will need to incorporate easy-to-use enrollment solutions to manage this uninsured market.

These solutions are especially important in order to both protect patients and to aid in diminishing the high price tag of benefits for employers.

Three solutions that hospitals should consider are:

(1) Coverage options rather than instant payment.

The demand for upfront payment for patient care creates an adversarial relationship between the uninsured patient and the provider. In order to establish amiability with a patient, hospital staff members should take steps to have a more comprehensive and engaging “insurance talk.”

When hospitals change this dynamic by employing staff to assist the patient in finding possible government coverage options and explaining them, patients will feel as though the hospital is on their side.

A two-year study we conducted of uninsured patients presenting at four busy emergency rooms at Sharp HealthCare in California revealed that 60 percent of the uninsured seeking treatment were actually eligible for government programs – but were not enrolled.

Focusing on coverage options rather than instant payments will protect both the patient and the hospital in the long run. For example, if a patient with no income and no coverage ends up needing more care because of a chronic condition diagnosis, the patient will wind up having to pay the hospital’s third party collection agency.

These bills may end up bankrupting the patient, resulting in negative feelings about the hospital. Also, the tone of conversation between hospital staff members and patients will be far more positive if the hospital staff members aren’t acting as debt collectors.

(2) Looking beyond Medicaid.

The good news is that hospitals are becoming much more vigilant about Medicaid enrollments. To this end, it’s also important for hospitals to inform patients about lesser known coverage and discounted-care programs, such as the children’s health insurance program in each state, various cancer-assistance options, hospital charity care assistance and third-party liability coverage.

In addition to indigent coverage plans in Pennsylvania, COBRA is becoming more widely used, as it covers formerly insured employees and their qualified beneficiaries anywhere from 18 to 36 months beyond employment depending on the qualifying event.

(3) Software solutions to eligibility awareness.

The other good news is that technology has made the process of enrollment easier through the growing use of portable hand-held software programs that can instantly inform uninsured patients of their options.

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