17.4 million now enrolled in high-deductible health plans: 5 findings

Crowe Horwath, a public accounting, consulting and technology firm serving multiple industries, has released the first-quarter 2015 edition of its hospital benchmarking data, which shows consistent growth in the share of uncompensated care associated with the insured patient population, and that hospitals aren't as prepared as they should be for the increasing popularity of high-deductible health plans.

The Crowe RCA Benchmarking Analysis includes 420 hospitals classified as acute-care, critical-access, rehabilitation, psychiatric or cardiovascular care facilities. The database contains information from hospitals in 35 states, with 20 or more facilities represented in Colorado, Florida, Indiana, Kentucky, Ohio, South Dakota, Texas and Wisconsin.

Here are five findings from the data.

1. The number of HDHP enrollees increased from 15.5 million in 2013 to 17.4 million in 2014.

2. Insured patients' share of total uncompensated care increased sharply from 2013 to 2014, with bad debt and charity rates up 22 percent and 130 percent, respectively, in Medicaid expansion states. In nonexpansion states, bad debt and charity rates were up 35 percent and 130 percent, respectively.

3. Only 7 percent of assessed facilities showed material use of HDHP codes, and 84 percent of facilities had yet to create specific HDHP codes in their patient accounting systems.

4. In Medicaid expansion states, Medicaid managed care plans increased 4.5 percent of total gross patient service revenue from 2014 to 2015.

5. Outpatient admissions in Medicaid expansion states increased 17 percent compared with a 2.5 percent increase in nonexpansion states. 

"These trends highlight the need for organizations to implement focused efforts with insured and underinsured patients," Crowe concluded. "Due to the increased financial risk from HDHPs and insured patient responsibility, organizations should evaluate uncompensated care in multiple segments: uninsured, HDHPs and other insured. By creating, tracking and assessing [key performance indicators] associated with different market segments, providers will be better equipped to adjust to market changes and align processes to improve patient financial outcomes."

 

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