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Charity Care in the Spotlight
By Bruce Nelson, Vice President, SearchAmerica, A part of Experian
A healthcare network’s charity care program has never been more important, especially when programs are growing at 100%. After all, more Americans are relying on aid to cover their medical bills, the public needs to hear about it to understand the industry’s community benefit, and the healthcare network’s financials need it to incorporate all qualified accounts to minimize bad debt.
Charity care is not new, but its importance and enrollment is on the rise. Recently, the Healthcare Financial Management Association (HFMA) published its Principles and Practices Board Sample Hospital Charity Care Policy and Procedures. The publishing of this document clearly demonstrates the industry’s need for attention to area and need for reform within existing programs.
Improving charity care is not easy, but it is necessary. This article discusses three best practices used by hospitals nationwide that deliver the most impact to a hospital, its patients and its community.
Proactive Communication
Many hospital patients are unaware that charity care exists from a healthcare network, not to mention the vast number of other financial assistance programs. Most do not know the proper questions to ask during the registration process, nor are they routinely screened by admitting personnel. The result is unsuccessful collection processes, undue worry placed upon the patient during their hospital stay and recovery period, and a missed opportunity for the hospital to live out its mission.
As HFMA’s sample policy suggests, awareness of a hospital’s policy can be improved with signage in the emergency room and other locations, appearance on billing notices, and the like. Unfortunately this still requires the patient to proactively ask the hospital for charity care, an action that many will avoid out of pride or misunderstanding.
Out of respect for all patients’ dignity, many hospitals are proactively screening all patients, especially self-pay, to see if they meet the network’s charity care guidelines. Hospital financial counselors can proactively discuss their charity care program with qualified patients to improve understanding and enrollment. This proactive, one-on-one communication is the key to respectful and complete disclosure of the charity care program.
Routinely Check Qualifications
Hospital policies and procedures are carefully developed and managed. This is especially true for a charity care program as each facility serves a unique community with specific financial and medical needs. Whether hospitals select to use a sliding scale to provide charity care or full coverage, it is critical to ensure that each patient is qualified to receive the appropriate level of charity care offered.
Most hospitals would assure their community that they are screening patients, but unfortunately they are not validating their financial status with each visit. Especially in today’s economy, financial situations can change daily for individuals. What they qualified for, or not, several months ago at their first visit may not be the same today. Routine screening at each visit, whether the patient is new or returning, will keep hospitals abreast of changing financial situations for each individual, taking into account layoffs, bankruptcies, foreclosures, etc.
Routine checking of qualifications will also discover when current charity care patients no longer qualify as their employment status and/or other financial changes dictates.
While the HFMA’s sample policy suggests an annual screening, hospitals have much to gain with higher frequency screenings as an important part of their policy.
Unbiased Enrollment
Every patient’s ability to pay for their services needs to be assessed independently. For example, in HFMA’s sample policy, it states that the eligibility of a patient must be based solely on their financial need and not any other factors.
Automating the screening process is a proven method used by a growing number of hospitals to remove any non-financial considerations from the screening process. When automated, hospitals can ensure that biases, such as age, gender, race, religious affiliation, etc., are eliminated.
Many hospitals have purposefully taken the human element out of the financial assistance qualification screening process to better serve their patients and also legally protect themselves against claims otherwise.
The Common Element: Automation
Third party services are most often the key ingredient to a successful charity care program. Specifically, the HFMA sample policy states that to determine financial need, hospital may “include the use of external publically available data sources that provide information on a patient’s or a patient’s guarantor’s ability to pay (such as credit scoring).”
Independent data sources equip hospitals with access to accurate and timely financial information that can be integrated into the registration system. This consistency and real-time access to information enables hospitals to identify qualified patients for their charity care programs while the patient is present, thus eliminating return visits to complete enrollment. Furthermore, it gives the hospitals confidence that every qualified is enrolled and greatly reduces the chances of unqualified patients receiving access to charity care benefits.
Hospitals must increase their commitment to delivering charity care programs that benefit their patients and themselves. Each should assess their communication and screening processes to ensure that they are serving their intended role to the fullest extent, and consider integrating automation as the cornerstone to their successful program.
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