Automated charity program cuts $1 million
from uncompensated care

continued from HFMA Visions, Issue 4

As recently as two years ago, anyone who walked into the hospital asking for care would receive it, says Majchrzak. “We didn't have a good system to verify income, and we didn’t have a good system to verify someone's address, so it was all on your honor,” he says. “We saw a lot of patients driving over an hour, passing by several other providers and coming to our facility simply because somebody said you can get free care here.”

Administrators knew it was time for an overhaul of their frontend process, so they completely retooled their charity-care policy. To implement the new policy within an automated registration process, they teamed with SearchAmerica®, a part of Experian, which provides automated financial screening services, and Emdeon®, which provides revenue and payment cycle solutions for health care.

The revamped registration process included technologies designed to implement Touchette's new charity-care policy and verify patient identity. Frontline personnel were trained on the new system and interpersonal skills, both of which are needed to make staff and patients comfortable with the computerized verification and eligibility system.

Registration personnel at Touchette were accustomed to doing everything manually, so it was necessary to have 30 people trained on how to use a new, automated eligibility system. "It was quite a kick-start, but I have to admit that it has made a dramatic change in our patients’ attitude, our revenue and our handling of charity," explains Pat Niel, Admitting Director at the hospital.

The hospital worked with SearchAmerica and Emdeon to customize a system that would retrieve information from credit reporting agencies and insurance carriers so that it could automatically calculate a patient's copay or eligibility for the hospital's charity-care policy based on existing coverage, the size of the household, household income and address.

SearchAmerica's service provides Touchette registrars with one of three possible responses to frontline personnel at the point of service:

• Probable — A patient qualifies for 100 percent charity
• Review — A patient qualifies to have 30 percent to 70 percent of their medical costs covered by charity care; the amount is determined after further financial information is provided by the patient to Patient Accounts
• Unlikely — A patient does not qualify for any charity care and is responsible for paying the full estimated cost of the procedure prior to receiving the service

With this information, frontline staff members know how to proceed with financial counseling of each patient even though they do not have access to a patient’s personal information, which is available only to the Patient Accounts department.

"There are going to be occasions when someone may have just lost their job within the week. That may not show up, but when you can be 90 percent free of all that [manual retrieving of information] and you can instantly communicate financial assistance to a patient at registration, that is excellent customer service," Niel says. "Patients can now be qualified for charity at the time of registration. This eliminates the additional step of asking patients to return with financial documentation and be subject to a timely review process."

"In the first six months of 2008, Touchette had about $8.8 million in uncompensated care, and in the first six months of 2009, we had $7.8 million, so we had $1 million in improvement," says Majchrzak. Even more interesting, while that improvement was occurring, the amount of charity care the hospital provided went from $3.5 million in 2008 to $5.6 million in 2009.

"Even though our total uncompensated care went down, our charity care has gone up, so to me this is showing that we are meeting the mission of taking care of those in our community who don’t have the ability to pay while at the same time performing a gate-keeper role for those who do have the ability or who don’t live in our community," Majchrzak explains.

In addition to coming out ahead financially, the hospital has ample evidence that frontline personnel are much happier, according to Niel, who oversaw implementation of the new system. Employees formerly had to make multiple calls, inconvenience patients, and sometimes send patients home to retrieve pay stubs or other documentation. Now staff can verify addresses, income, insurance and charity-care eligibility via computer at the point of registration. "It provides the staff with sufficient knowledge at the time of registration to counsel the patient on their insurance eligibility and/or their charity eligibility," Niel adds.