This article appears in the May 2012 issue of HealthLeaders magazine.
One of hospitals' most vexing problems is absorbing the cost of care from the uninsured. For years, these patients have been called self-pay, but that term is a misnomer. In most cases, it's code for non-pay. The reasons they don't pay are numerous and complex, but some hospitals and health systems are starting to figure out there's a better way to get reimbursed, one that is less stressful for the patient and more efficient for the provider.
Hospitals can try to help patients achieve coverage, but such efforts can be uneven because of the huge variety of assistance programs other than Medicaid, each with its own bureaucracy. There are also time limits for reimbursement dependent on the date of service, and the patient has to take some action, which is often overly burdensome.
The way some hospitals deal with this group of patients has sometimes led to embarrassing outcomes—some have been taken to task for aggressive collection efforts. Such relationships are hardly good grist for a great patient experience, either. Historically, attempts at solving this problem have proved laborious—for little tangible return.
In the emergency department, hospitals are required to provide care regardless of a patient's ability to pay, but many hospitals also provide needed care outside the ED to those who cannot afford to pay for it. Whether the hospital or health system ultimately receives any reimbursement for that care depends on a confusing mishmash of collection efforts and patient-dependent navigation of public assistance programs, often compounded by patient embarrassment or sometimes plain indifference. But many—even a majority—of these patients qualify for some form of financial assistance, according to the Foundation for Health Coverage Education. Both hospitals and patients are left clamoring for innovative solutions to cut down on the complex, labor-intensive bureaucracy that stymies their ability to access these sources of reimbursement.