While employers in New York state are bracing themselves for the expected impact of the Affordable Care Act (ACA) on health-insurance premiums in January, 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 (ERs), which will be affected the most by the increase in patient volume, can be proactive in educating patients on new coverage options and eligibility.

While the ACA 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. Even with the New York Health Benefit Exchange going live this 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.

U.S. hospitals lose billions of dollars each year largely due to unpaid ER bills. In 2010, U.S. hospitals provided a record $39.3 billion in uncompensated care with ERs incurring a significant percentage of that cost. By 2019, according to the National Association of Public Hospitals and Health Systems, hospitals will provide $53.3 billion more in uncompensated care costs unless major efforts are taken to enroll uninsured patients in available programs. 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. 

With 22 percent of the population in New York state living in poverty and millions becoming 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:

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, conducted by the Foundation for Health Coverage Education, of uninsured patients presenting into four busy emergency rooms at Sharp HealthCare in California revealed that 60 percent of those 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 end. For example, if a patient with no income and no coverage ends up needing more care due to 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.

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 CHIP (Children’s Health Insurance Program) in each state, various cancer-assistance options, private guarantee-issue plans, hospital charity-care assistance, and third-party liability coverage. In addition to indigent coverage plans in the state of New York, 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.

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. One technological medium, PointCarePA, a Web-based eligibility software that consists of a simple five-question quiz, helps hospital staff to quickly and efficiently screen uninsured patients for their coverage options. The screening produces a list of personalized coverage options that allow for a more positive and engaging conversation between the hospital staff member and the patient. The list includes program contact information, monthly costs, sign-up checklists of important documents needed to enroll, applications, and online enrollment links.

Using these solutions to alleviate the shifting of uncompensated costs onto the premiums of businesses in New York is just one small portion of a larger process-improvement strategy that needs to be created to prepare hospitals for managing the impact of the ACA.

Ankeny Minoux is president of the Foundation for Health Coverage Education (FHCE) and COO of the new company PointCare (www.pointcare.com) — an outgrowth of the nonprofit organization.