Do you tell patients about charity care?

Many unaware of programs

Your patient access department already might have a discount policy in place, but this policy doesn’t do anything to help a patient unless he or she is aware of it.

Patients often have no idea about the charity care programs available to them, says Jessica Curtis, director of Boston-based Community Catalyst’s Hospital Accountability Project, a national consumer advocacy organization focusing on healthcare issues.

“Even in cases when patients do ask about it, there is often no follow-through to help the patients go through the process, especially for non-English speaking patients,” she says.

While some patient access departments go above and beyond to help patients to apply for financial assistance or public programs such as Medicaid, says Curtis, “what is troubling is that it is not commonplace.”

Patients uninformed about existing discount or charity care options might delay care or put the balance on a credit card and fall behind on their mortgage or rent, says Curtis. “The problem is well-documented,” she says. “The question is: What are some of the things that a hospital can do that allows them to collect what they need to, but also treat the patient fairly?”

In many cases, patients have no idea of their out-of-pocket responsibility until they receive bills in the mail and start to hear from collection agencies, says Curtis. “At that point, they are definitely in the back end of the cycle,” she says. “In many cases, they contact legal services because they just don’t know where to go. They might find they are eligible for public assistance, or that they could have asked about the hospital’s financial assistance policy.”

More changes for access

There are other recent developments that could change the job of patient access employees, says Curtis. (See related story on legislation involving hospital collections, below right.)

“There are some things in the works that would limit or at least prescribe what front-end staff should be saying and doing and in what order,” says Curtis.

The Patient Protection and Affordable Care Act (PPACA) requires all nonprofit hospitals to notify patients about financial counseling policies, she notes. “Their policy can be pretty bare bones, or it can be comprehensive,” Curtis says. “Right now, it is up to hospitals to decide whether they want to offer any help to uninsured or underinsured patients.”

In addition, the U. S. Department of the Treasury released proposed regulations related to these new requirements for non-profit hospitals. Both the PPACA and the Treasury Department rules require non-profit hospitals to make a “reasonable effort” to qualify patients for financial help prior to engaging in certain collections activities. “These would require that patients need to be notified about financial help during any conversations about their bills,” Curtis says. “That is something that patient access should be thinking about right now.”

Examine policies

The Supreme Court’s recent ruling giving states the option whether to expand Medicaid also has implications for patient access, says Curtis.

“In a state that chooses not to pursue the expansion being offered by the feds, hospitals will still see the lowest income patients coming through their doors, and those patients will still be uninsured,” says Curtis.

The intent of the Medicaid expansion included in the PPACA was that even if hospitals weren’t receiving as much revenue as with commercial insurance, they still would be receiving some revenue, says Curtis.

Curtis points to Massachusetts’ experience with healthcare reform. “We haven’t gotten rid of uncompensated care entirely. Hospitals still have some bad debt,” she says. “But we can expect that with the PPACA, both of those amounts will go down.”

Curtis says patient access should take a look at their financial collection policies and “do it yesterday. Hospitals should be re-evaluating this at the board level.” She says patient access leaders should ask the questions: Where do we do a really good job of connecting patients with information? Where do we need to improve?

“They have crucial information that should be shared with hospital leadership,” Curtis says. “It could be they have great policies, but the tools to implement them aren’t good enough.”