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Creating a Comprehensive Assistance Program for uninsured/underinsured. AAHAM November 2010. Increased Revenue Cycle Technology = Greater ROI and Added Jobs: The BayCare Health System Story . Lou Ann Watson Medical Assistance Manager BayCare Health System. BayCare Health System.

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Creating a comprehensive assistance program for uninsured underinsured

Creating a Comprehensive Assistance Program for uninsured/underinsured

AAHAM November 2010


Increased revenue cycle technology greater roi and added jobs the baycare health system story

Increased Revenue Cycle Technology = Greater ROI and Added Jobs: The BayCare Health System Story

Lou Ann Watson

Medical Assistance Manager

BayCare Health System


Baycare health system
BayCare Health System Jobs:

  • Mission:

  • To improve the health of all we serve through community-based healthcare services that set the standard for high-quality, compassionate care

Community-based healthcare system in the Tampa Bay area

*Ambulatory Care Division surgery, imaging, wellness access points **Includes endoscopy+ 2009 billable tests^Unreimbursed costs for traditional charity care, Medicaid and county welfare programs, indigent care fund payments and unbilled community services in 2009.


Baycare health system1
BayCare Health System Jobs:

  • Member hospitals formed in 1997 under a common mission and shared values

  • Private, non-profit

  • Specialty Hospitals - Children’s, Women’s, Trauma, LTACH

  • Behavioral Health and Rehab Services

  • Unique patient populationsand hospital identities

“As an organization, our mission is to improve the health of all we serve, regardless of their ability to pay.“

~Steve Mason, CEO, BayCare Health System


Baycare approach to the uninsured
BayCare Approach to the Uninsured Jobs:

  • Established a health system-based Medical Assistance Program to support uninsured, underinsured and non-citizen patients in 1999

PURPOSE

Increase access to community-based healthcare for at risk patients and ensure their ability to obtain financial assistance for health care expenses

Financial concerns should not deter anyone form seeking medical care

Committed to serving community residents with compassion and dignity regardless of their ability to pay

Do the right thing for the patient…every time

GUIDING

PRINCIPLES


Why a health system based program
Why a Health System Jobs: Based Program

Ensures our culture and our values

High visibility as a corporate directed and managed department

Patients seen regardless of financial outcome

Team members easily move between hospitals

Follows our compliance program

Very low cost to collect

Low turnover and easier to train

Health system experts for uninsured issues

Addresses Mission and Fiscal Responsibility


The medical assistance team

Help patients and families Jobs: access assistance for health care through community, state, and federal programs

Advocacy, education and support are emphasized in a patient-focused, social work approach

Patient outreach in conjunction with strong community partnerships ensures successful outcomes for patients and a financial benefit to the hospital

Medicaid

Florida

KidCare

Payment

of COBRA

premiums

County

Health Care

Plans

Medical Assistance Programs

HCRA

BayCare

Hardship

Charity

Victim’s

Compensation

AHCA

Charity

The Medical Assistance Team


A patient centered process
A Patient Centered Process Jobs:

  • Conduct interviews at the time of service – inpatients at the bedside, in the emergency room, and pre- and post-service

All hospital accounts included for assistance

Financial assistance screening and application submission for uninsured and underinsured patients

Current and future needs met

Education and support provided through final disposition to patients and families


Florida unemployment
Florida Unemployment Jobs:

  • The economy has an immediate impact on patients’ ability to pay – experienced a 38% increase from Jan 2009 – Jan 2010


Florida uninsured rate 21
Florida Uninsured Rate – 21% Jobs:

  • Average percent uninsured by state 2006 – 2008

  • Florida ranks 3rd in the nation in uninsured

  • 2nd highest % of uninsured children

  • 26.6% under 65 are uninsured

  • More uninsured than Medicare eligibles

  • Uninsured rate is up 40% since 2000

Source: US Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2008. Data released August 2009. Link: http://www.census.gov/hhes/www/hlthins/hlthin08/hlthtables08.html.

*The Uninsured: A Closer Look, Families USA, March 2009


Challenges in our community
Challenges in Our Community Jobs:

  • Increased number of uninsured patients entering our emergency rooms and unable to pay for services

  • Economy worsened in 2009 causing layoffs

  • Uninsured patients have difficulty accessing the health care system outside of the ER for primary care needs

  • Uninsured in our area runs between 19% - 21%

  • Service industry and “young” retirees

  • Significant undocumented populations

  • Existing process had reached a plateau


A need to expand and embrace technology
A Need to Expand and Embrace Technology Jobs:

  • Maximize health system control of growing uninsured population

    • Address patients accessing health system’s many doors for help

    • See more patients – particularly in the ER

  • Lessen paper and manual processes

  • Increase productivity, accountability and standardization

  • Appropriately identify patients eligible for charity and community programs – state and federal requirements

“We cannot become what we need to be

by remaining what we are.”

~Max Dupree


Opportunities for expansion
Opportunities for Expansion Jobs:

  • Children are a priority and can be easily covered

  • A portion of the population will qualify for Medicaid or other insurance coverage

  • Future benefit — Medicaid patients return 2 or more times for service

  • Once insured, patients can access physicians, etc.

  • Potential reimbursements from charity


Emergency room medical assistance

The Program: ERMA Jobs:

Implemented in April, 2009

20 positions added

WOWs – workstations on wheels

ER patient interviews – 7 days a week, 12-15 hours per day

“Missed” inpatients caught (weekend and short stays)

The Tool: TransUnion Revenue Manager

Interview tool for all team members

Integrated process from beginning to end

Centralized patient information

Allows for partnerships with community agencies and grant programs

Emergency Room Medical Assistance


Revenue cycle technology
Revenue Cycle technology Jobs:

  • Incorporated external demographic and financial data into front-end processes

    • Verifies patient identity and eligibility for financial assistance at the time of registration

    • Provides real time alert messages to financial counselors

    • Ensures data accuracy

    • Simplifies the eligibility determination process

    • Matches patients and families to the right programs

    • Automates the application process

  • Collaborating with Medicaid for direct submission


Factors for success
Factors for Success Jobs:

  • Everyone involved

  • Consistent approach

  • Cross-functional training

  • Measurable accountabilities

  • Map current and desired processes

  • Continual refinement

  • Align people to processes

  • Identify key owners / sponsors


Patient hospital and community benefit

Patient satisfaction and peace of mind Jobs:

Treatment continuity in the community

Direct patients to more appropriate community-based healthcare

Decreased return mail

Charity versus bad debt

System data base to continually monitor & profile our populations

Additional financial gains

Decreased collection agency (health system-owned) costs

Patient, Hospital and Community Benefit

  • Reimbursement for all providers


Applied programs
Applied Programs Jobs:

5,811 patients

7,864 patients



Effect on our population of children coming into the ed
Effect on our population of Jobs: children coming into the ED

Average Variance 3%







Ongoing considerations
Ongoing Considerations Jobs:

  • Maximization of Charity and Medicaid Eligibility

  • Healthcare Reform

  • Non profit status – IRS Form 990 disclosures, annual cost report disclosures

  • Transparency – discount and charity policies

  • Medicaid eligibility expansion in 2014

  • LIP – Low Income Pool (Florida)

  • Exemptions from Medicaid limits so hospitals are paid based upon costs/allocations additional funding driven off Medicaid, charity and 50% of bad debt

  • HITECH

  • Payments for implementation of an electronic medical record/meaningful use are impacted by a hospital’s charity in relation to total charges. This definition of charity is the federal definition which reverts back to the hospital’s policy.


Next steps
Next Steps Jobs:

  • Ensure more patients are reached

  • Maximize outcomes for each hospital

    • If North Bay Hospital were to meet the 11% threshold of Medicaid/charity utilization, the increase in Medicaid reimbursement would be about $1.2-$1.4M

  • Presumptive eligibility process

  • Involve more community partners in the process

  • Continuous improvement and reporting


Questions and discussion

Strapping New Technology on Old Business Jobs:

Will Not Propel You in the Right Direction

Questions and Discussion


Contact information
Contact Information Jobs:

  • Lou Ann Watson, CPAM

    • Manager of Medical Assistance

    • BayCare Health System

    • Office: (727) 709-6083

    • LouAnn.watson@baycare.org

    • www.baycare.org