A report from The Commonwealth Fund estimates Mr. Trump’s Medicaid block grant program will leave 25 million Americans uninsured, yet hospitals still have an obligation to provide care for these patients. An executive roundtable at the Becker’s Hospital Review 5th Annual CEO + CFO Roundtable sponsored by Alltran brought hospital executives from around the country together to discuss their solutions for serving the uninsured and underinsured population.
Develop a support system
The first thing hospitals must do, said Jack Highsmith Jr., vice president of operations at Alltran, is identify the cost difference between the uninsured and underinsured. CFOs can then discuss the bad debt with their CEOs and develop solutions to ensure frontline workers optimize each patient arriving at the hospital’s emergency department. The ED’s workflow should accommodate uninsured and underinsured patients with a triage team to provide counseling, screening for insurance eligibility and social services to support all aspects of patient care.
Certain states offer subsidies for hospitals to employ social service workers in the ED as well as workers stationed throughout the community to serve the uninsured. The social services workers are trained to proactively meet with uninsured patients and discuss treatment options, counsel them on insurance and work with registration teams to navigate the healthcare system.
Some health systems find other arrangements for these services aside from direct employment. For instance, the CFO of a safety-net hospital in Atlanta brought in third-party partners to assist with insurance eligibility verification. Included in the hospital’s program is an application that pings the state Medicaid services daily to look for insurance that may have become available for uninsured patients or secures Medicaid coverage for those who qualify. The hospital saw its uninsured rate drop significantly after working with this partner and reported a return-on-investment for their efforts.
“We are looking for frequent utilizers,” said the CFO. “If someone comes into your ED every few weeks, it does pay to get them qualified [for health insurance coverage].”
The next challenge is maintaining consistent follow-up with these patients to track their progress and outcomes.
Partner for post-acute and follow-up care
Hospital executives mentioned a variety of strategies for transitions of care among uninsured and underinsured, and specific solutions for post-discharge care for homeless patients.
The vice president of network care from a Southern California-based health system with 16 acute care hospitals reported her hospitals entered into a collaborative relationship for post-acute care among the homeless population. Medi-Cal allows for two weeks in post-acute care for homeless patients to recover in a healthy and safe facility with the goal of avoiding readmissions and lowering the length of stay at the hospital.
The Atlanta hospital CFO said his hospital partnered with an acute care rehab facility and skilled nursing facility as preferred providers for uninsured and underinsured patients to stay up to three weeks. The hospital also employs a psychiatrist, nurse and social worker to travel as a team into the community and find patients in shelters or on the streets to provide preventive and follow-up care. The team ensures homeless patients posess the proper medications and take them appropriately.
“We sold that concept to other counties in Georgia, but it takes an investment,” said the CFO.
The Southern California health system also partnered with a nonprofit organization for clinicians to provide similar services by bike, making rounds to visit the homeless staying on the riverbed. The hospital’s team includes a medical assistant, nurse practitioner and veterinarian to serve homeless people’s pets and address health risks associated with those pets.
Collaborate to cover rural patients without access to PCPs
Hospitals serving large rural populations often see patients who don’t have primary care physicians and are unwilling to travel long distances for follow-up care. The associate CFO from a health system in Missouri reported the hospitals in his system couldn’t refer patients from rural communities back to their home setting because primary care physicians or pharmacies that could provide the prescribed drugs were unavailable.
“You have a population that is uninsured for whatever reason and they don’t have follow-up care,” he said. “The front-end team is dedicated to providing access for these people, but they don’t have eligibility [in a non-expansion state].”
Mr. Highsmith recommended hospitals in these situations invest in one or two additional full-time administrative employees to manage uninsured or under-insured patients. A few states will subsidize these workers’ salaries to help the uninsured achieve coverage. Hospitals can also collaborate with a business partner to outsource the administrative positions to help the uninsured or underinsured patients receive coverage when possible. “Really look at evaluating your present state versus where you want to be in the future,” said Mr. Highsmith. “Look at your goals for increasing your outcomes and move toward that.”
If a hospital does bring on certified application counselors, it’s important to track their progress for cost-efficiency and make changes if necessary.
“Walk through the process to define what is needed and your current results,” said Mr. Highsmith. “Find the targeted results, process control and then benchmarking standards. One of the challenges in the market today is that someone is just looking at the bottom line profit. The ultimate goal is to deliver quality clinical care to patients.”
Stacy Baumgart, regional manager of Medicaid eligibility at Alltran, recommended hospitals examine whether they could take better advantage of presumptive eligibility — a policy option for providers, including federally qualified health centers, to connect patients to Medicaid based on their gross income, household size and other demographic information. The program can temporarily enroll eligible children or adults in CHIP or Medicaid without requiring a wait for their application to be fully processed. Effective in 2014, the ACA allowed states to extend presumptive eligibility beyond just pregnant women and children to parents and adults. This means healthcare providers can receive payment for services provided to the patient during the interim period pending a final adjudication of Medicaid eligibility by the state.
More articles on Medicaid:
Trump picks Price, Verma as heads of HHS, CMS: 9 things to know
3 things to know about the uncertain future of Medicaid expansion
CMS updates online tool for tracking drug prices
