Becker's Hospital Review

Save the date! Becker's Hospital Review Annual Meeting – May 7-9, 2015 – Chicago 18 for charity programs," says H. Gene Lawson, Jr., senior vice president of rev- enue cycle management at Parkland Health & Hospital System. A recent Urban Institute survey, based on an Internet sample of 7,500 adults between ages 18 and 65, found nearly 60 percent of the uninsured population cited not being able to afford coverage as the reason they remained without health insurance, and 62 percent said they were unaware federal subsidies were available to lower their insurance costs. To help address the issue, Parkland is using technology that allows staff to see if a patient qualifies for the hospital's charity care program or to purchase in- surance off of the exchanges under the PPACA. This helps to ensure patients are aware of their financial assistance options. At Downers Grove, Ill.-based Advocate Health Care, the financial assistance program has remained the same since the passage of the PPACA. "Advocate's charity care program is there for qualifying patients who cannot afford to pay for all or part of their care," says Gregory Harden, vice president of finance, operations and strategic financial planning at Advocate Health Care. For some, charity care is the only option Hospitals reducing the amount of charity care they are offering will be ex- tremely troublesome for low-income people living in the more than 24 states that have not expanded Medicaid. The PPACA originally required states to expand their Medicaid programs to cover those earning as much as 138 percent of the federal poverty level. The expansion was intended to apply to all states; therefore, the health reform law did not provide insurance premium tax credits for those earning below 138 percent of the federal poverty level. However, a 2012 Supreme Court decision made Medicaid expansion optional. Nationally, 4.8 million uninsured adults in states not expanding Medicaid fall into a coverage gap, meaning they earn too much to qualify for Medicaid but not enough to be eligible for subsidized coverage. For example, in Missouri, where BJC HealthCare is scaling back its charity care program, Medicaid has not been expanded, and according to Kaiser Family Foundation data from April, more than 193,000 people in Missouri fall into a coverage gap. "Fundamentally, PPACA plans and charity policies must support each other by filling in gaps for patients in need," says Mr. Lawson. His view is supported by the numbers, as only 16 percent of Parkland's charity care patients qualify for a health plan under the PPACA. Should hospitals cutting charity care do more to educate patients? Scaling back financial assistance for patients will not be an effective way of getting the uninsured to sign up for health coverage, if the health literacy problem is not addressed. Just weeks before open enrollment for state and federal exchanges began last year, 42 percent of Americans were unable to explain a deductible, and 62 percent did not know a HMO plan had greater restrictions than a PPO, ac- cording to a study by researchers at the University of Southern California's Schaeffer Center for Health Policy & Economics in Los Angeles. Research- ers also found low-income and uninsured Americans — those most likely to seek charity care — had the least awareness of health reform. An Urban Institute survey also found 41 percent of those who were uninsured in 2013 and remain uninsured are unfamiliar with the insurance marketplaces. Language barriers are also a problem for many of the uninsured. A study from the Greenlining Institute found 90 percent of Covered California en- rollees speak English as their primary language, despite over half of all Cali- fornians and 40 percent of those eligible for Covered California having lim- ited English proficiency. Although specific to California, the study's findings indicate many people may forego enrolling in insurance under the PPACA because of a language barrier. Some hospitals take the middle ground In New York, Florida and Wisconsin, some hospitals are exploring ways to as- sist low-income consumers who are struggling to pay the premiums for their government-subsidized insurance plans to not only help people stay insured but also to help ensure the hospitals get paid. Although these programs could cut down on the number of patients receiv- ing charity care, they are not gaining the support of insurers who have written to the Obama administration about their concerns that hospitals are acting in their own financial interest by creating the programs. The insurers believe the premium assistance programs will drive up costs for everyone and po- tentially discourage people in good health from purchasing health coverage. Along with facing payer resistance, it is still unclear whether federal regula- tors will permit hospitals to create premium assistance programs. In 2013, several healthcare organizations, including St. Vincent's Health System in Birmingham, Ala., showed interest in assisting low-income individuals with their health insurance premiums. In October 2013, the Obama administration sent a letter to Rep. Jim McDer- mott (D-Wash.) that said plans sold through the insurance exchanges were not considered federal healthcare programs, which indicated healthcare organiza- tions could assist subsidized policyholders in paying their premiums. However, in November of last year, CMS discouraged hospitals and drugmakers from making "third party payments" because they could "skew the risk pool." Even with the uncertainty surrounding the programs, some groups, includ- ing the South Florida Hospital and Healthcare Association in Dania Beach, Fla., are seeking donations from their hospitals to help assist consumers with their premiums. The future of charity care While several healthcare organizations have decided to scale back the fi- nancial assistance they offer, a great deal of hospitals and health systems are choosing to leave their charity care programs in place and unaltered for the time being, which will help ensure low-income individuals are able to afford the medical services they need. n Sell Your Surplus Surgical Inventory to eSutures.com eSutures.com Don't let your extra product inventory go to waste! eSutures.com is a discount distributor of name brand suture and endomechanicals, implants, instruments – and much more. We purchase in date, short dated and expired products in full selling units, open boxes and even individual loose units. 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