Many providers are already seeing the payoff from insurance
expansion across the country, but those that haven't are redoubling their sign-up efforts to reach the most challenging of their uninsured patients
, said panelists at the Healthcare Financial Management Association's
2014 Annual National Institute.
Cooper University Hospital is located just across the river from Philadelphia in Camden, N.J., a city with a 40% poverty rate. It also sometimes holds the distinction of having the country's highest murder rate. Its Level 1 trauma center often receives the victims of violent crime, including gunshot wounds.
“The biggest challenge was to convince people we were doing something good for them” by encouraging them to get insurance, John Bucci, Cooper's director of patient accounts, said during the presentation. “There are a lot of people who walk in and they're not ready to cooperate.”
Cooper set up kiosks throughout the hospital and offered a toll-free number where individuals could get more information about signing up for a health plan. However, many people balked when they realized they'd have to pay for the premiums. “We didn't really have a huge reaction to it,” Bucci said about the hospital's exchange enrollment efforts. Some patients who did sign up would pay a month or two of premiums and then stop, he said.
The biggest boost for the hospital is New Jersey's presumptive eligibility for Medicaid, which allows a patient to automatically qualify based on income. Already the number of self-pay patients has dropped 40% and charity care has decreased by a third. “It's very preliminary, but it's very positive,” Bucci said.
The University of Florida Health Jacksonville hasn't seen the expected enrollment response and plans to continue its outreach, said Jason Hardwick, director of patient access and financial eligibility. Florida didn't expand Medicaid.
Next year, UF Health plans to partner with a third-party, not-for-profit foundation that will offer premium assistance to eligible individuals. “We're starting to take some different steps utilizing those community resources,” Hardwick said. “We're going to offer (patients) an opportunity to get assistance with premium payments so that's not a factor.”
Cooper is already taking that route. “We've provided a lot of premium assistance,” Bucci said. “Frankly, we've paid premiums.”
LifePoint Hospitals, the publicly traded, Brentwood, Tenn.-based chain, reported in its first-quarter results that 22% of its self-pay patients had enrolled in Medicaid and 3% had enrolled in an exchange plan. Those numbers were above its expectations. Moreover, concern about bad debt from high-deductible exchange plans has been unwarranted.
“Our average patient responsibility is $176,” said John Kerndl, LifePoint's chief financial officer of operations, on the panel. “It's been a pleasant surprise.”Follow Beth Kutscher on Twitter: @MHbkutscher