Have effective self-pay processes? Facility's fiscal health is at stake

New financial counseling role for registrars

Hospital stays for uninsured patients increased 21% between 2003 and 2008, according to a new report from the Agency for Healthcare Research and Quality (AHRQ).1 "Increased use of hospitals by uninsured means treating more uninsured patients and probably hospitals absorbing more costs," says P. Hannah Davis, MS, the study's co-author and a senior program analyst at AHRQ.

Researchers found that there were 2.1 million uninsured admissions in 2008, compared to 1.8 million in both 2003 and 1998, with the average cost of a 2008 uninsured hospital stay at $7,300.

Increased uninsured hospital stays affect hospital capacity, causing more patients to be held in the emergency department due to lack of available inpatient beds, says Davis. "The increase in uninsured hospital stays may mean that some of the visits could have been prevented, had earlier care been given," she adds.

New era for registrars

Registrars at Advocate Illinois Masonic Medical Center have seen almost a 10% increase in uninsured patients since 2009, for inpatients and outpatients.

"Our department has implemented several changes to accommodate the amount of uninsured patients," reports Philip N. Quick, CHAM, the hospital's manager of patient access and bed management, adding that about 60% of the hospital's admissions come from the emergency department. "We began to brainstorm potential solutions," says Quick. "We realized that we needed to start at the patient's first point of entry to the hospital, and in many cases, prior to service."

The hospital's revenue cycle leaders developed an action plan based on "financial advocacy." Together, they created a standard way to determine the patient's financial responsibilities, discuss payment options, and collect and/or set up a payment plan before or at the time of service, says Quick. "This initiative required us to look at the revenue cycle process for all inpatient, outpatient, and emergency department patients," he says.

The group's goal was to increase point-of-service (POS) collections, while at the same time reducing the cost of collection to outside vendors, says Quick. Registrars are now required to accurately and promptly identify the patient's financial responsibility and make an effort to collect on that estimated amount or initiate the financial counseling process, he says. As a result, more time is needed to process a registration and educate patients about financial options at the earliest possible point in the revenue cycle, he says.

"The days of only taking demographic information are long gone. We have entered an era of true financial consulting," says Quick.

If your registrars are seeing increasing numbers of self-pay patients, "the implications stretch far beyond the realm of just patient access services," says Quick.

More self-pay patients affect the organization's overall growth, as well as the charitable dollars and other resources available throughout the hospital, he says. "To be frank, as this trend continues, it will be difficult for organizations to sustain adequate financial performance without taking the appropriate measures," Quick warns.


1. Stanges E, Kowlessar N, Davis PH. Uninsured hospitalizations, 2008. HCUP Statistical Brief No. 108. April 2011. Agency for Healthcare Research and Quality, Rockville, MD.  


For more information on patient access processes for uninsured patients, contact:

• Le'Kita Brown, Manager of Patient Financial Services and Sponsorship, Ohio State University Hospital, Columbus. Phone: (614) 293-4241. Fax: (614) 293-6065. E-mail: Lekita.Brown@osumc.edu.

• P. Hannah Davis, MS, Senior Program Analyst, Agency for Healthcare Research and Quality, Rockville, MD. Phone: (301) 427-1698. Fax: (301) 427-1430. E-mail: Hannah.Davis@ahrq.hhs.gov.

• Philip N. Quick, CHAM, Manager, Patient Access & Bed Management, Advocate Illinois Masonic Medical Center, Chicago. Phone: (773) 296-8303. Fax: (773) 296-8119. E-mail: philip.quick@advocatehealth.com.