As hospital and health systems enter a new financial disruption era led by rising costs, the rapid adoption of AI and coverage loss, healthcare leaders are bracing for unprecedented changes.
Over the next few years, the Congressional Budget Office projects millions of people will be uninsured, with a warning that increasing labor market instability, partly driven by AI, could further expand the number of underinsured and uninsured patients.
These shifts signal new operational challenges and stricter margins for CFOs.
Here are four key actions the American Hospital Association has outlined for finance leaders to strengthen their organizational resilience:
1. Audit and ensure compliance with good faith estimates. Hospitals must provide self-pay and all uninsured patients with good-faith estimates for scheduled care, and patients who have a final bill exceeding their GFE by $400 or more can take part in a dispute resolution process. As more patients are expected to lose coverage, CFOs can audit GFE processes now to ensure accuracy, capacity and compliance as they manage growing demand.
2. Consider implementing presumptive eligibility for charity care. Hospitals may see rising uncompensated care levels as more uninsured and underinsured patients arise. Presumptive eligibility screenings, which use financial and other data to assess patient needs, can help find those who qualify for assistance and reduce hospital administrative burdens.
3. Monitor price visibility. Utilization of negotiated rate data has been relatively low for years, although hospitals and insurers are required to post it. As AI tools make price information easier to access and data quality improves, more employers and consumers are expected to explore their use. Hospitals could monitor leading public tools to see how their pricing data shows up.
4. Develop an AI action plan. AI is expected to emerge as a powerful administrative tool, electronic medical records systems are developing features to automate tasks like appeals for denied claims. Leaders might want to explore how these technologies can help ease financial pressures and streamline operations amid ongoing resource constraints.
