Population shifting to uninsured, underinsured

Staffing needs are changing

You might be seeing a decrease in your "financial buckets" of insured patients, and an increase in underinsured or uninsured patients, without a corresponding increase in the number of services rendered.

"This is a clear sign that the patients have shifted from being insured to limited or uninsured," according to Le'Kita Brown, manager of patient financial services and sponsorship at Ohio State University Hospital in Columbus.

Another signal is an increase in volume of emergency department services, which indicates that services that would have been received in a doctor's office setting are being managed at the emergency department level, Brown says. "Due to a patient's lack of coverage, they seek the services from the emergency room for minor complaints instead of utilizing a primary care physician's office," she says. "This is misuse of the emergency department."

Due to the increase in uninsured patients at Ohio State University, some staffing changes were made in the areas of preregistration, scheduling, and financial counseling, says Brown. The hospital also made some process and policy changes at the administration level, she says. "When the economy changed, we as an organization knew we would also have to change to be able to support our community and the overall revenue cycle of the hospital," says Brown.

Patient access leaders formed a committee to work toward changing the healthcare system's culture, which included educating the staff, the patients, and the medical team, she says. "Our goal was to streamline the throughput process of a patient's care from start to finish," says Brown. "By streamlining the process, our hope was to ensure each patient received financial clearance prior to the service being rendered."

Over the past few years, patients have become more willing to take care of their financial responsibility prior to service, she says. "We expanded the preregistration service and registration department roles, to ensure that the financial communication and screening process is initiated prior to scheduling," Brown says. These steps are taken:

1. If the patient bypasses the preregistration checkpoint, and it is determined that the patient has no coverage at time of registration, then the registrar starts the financial evaluation process.

2. During the evaluation, if the patient doesn't meet the criteria for charity, he or she is referred to a financial counselor prior to their appointment to set up a possible payment plan.

3. If it's determined during the evaluation process that the patient might qualify for other financial assistance programs such as Medicaid or high-risk insurance, a financial counselor starts the application process.

"With every process change, there are pros and cons," says Brown. "The hope is that the end result will outweigh the cons. In our case, we have been very successful."

Registrars more mobile

To ensure that the department was capturing as many patients as possible, management invested in portable work stations so registrars could be more mobile. Also, registrars are now alerted of upcoming uninsured patients or patients with limited coverage.

"That allows us to have a jump start on working with these patients, prior to their scheduled date of service," says Brown.

The staff was reorganized, to have more individuals in high-dollar areas such as the emergency department, radiology, and prenatal areas. "This also helped us to deal with one of the biggest 'cons' of this culture change: increased registration time," says Brown.

Patients are more satisfied with the new process, she reports. "We are able to educate patients that no insurance, or limited insurance benefits, are not always a problem when you have a solution and a healthcare system with the ability and willingness to assist you through the process," Brown says.