These 4 changes are already in place

Some changes are 'good news'

Some of the requirements in the Patient Protection and Affordable Care Act (PPACA) already have been implemented and have changed patient access processes, notes Michael F. Sciarabba, MPH, CHAM, director of patient access services at Advocate Illinois Masonic Medical Center in Chicago. Here are four changes the department is seeing:

1. Increased numbers of young people up to age 26 are covered under their parents' insurance plans.

"We are already seeing an expansion of insurance. If everything continues as planned with healthcare reform, that will be even more so," says Sciarabba. He expects to see far fewer self-pay patients in 2014 who would not have been covered otherwise.

The expansion of Medicaid will significantly decrease the hospital's charity care population, he adds. "We have a high population of patients who don't qualify for Medicaid and don't have insurance, so they are self-pay," says Sciarabba. "We end up making payment arrangements for them, but a lot of that is just lost dollars. So that is good news for us."

2. Pre-existing conditions can no longer be excluded by health plans.

This change already has benefited members of the patient access staff, says Sciarabba, "because before, we were the bearer of that bad news. There are no more lifetime limits and annual limits. All of that has gone away."

3. It takes longer to determine eligibility with commercial and managed care plans.

"All of this calls for a higher level of education and skill," he says. "Staff have to know many more intricacies of coverage. Even though we are using electronic systems, it takes more time than it did before."

4. Financial counseling has become more important.

This counseling often is necessary, because patients with commercial insurance don't understand their benefits. "With the ACA, we will have to provide even more counseling related to benefits and coverage," Sciarabba says.

Because patients will be able to change coverage more often, patient access will take on a "navigational" role to help patients understand the various options, he adds.

"We will have to be a lot more helpful to patients," Sciarabba says. "With all of the online tools, computer systems, and a myriad of different tasks, the diversity of our skill set is going to be greater than ever."