Help ER patients get coverage, save millions

Tools

It's disheartening to see the compost heap of words that was Illinois' recently passed Medicaid law revamp harbored a minimum $10 million a year tax break for the state's 28 for-profit hospitals. As I said, if you can't read something, it's because the author doesn't want you to.

Nor am I particularly amused one of the key authors of the bill left the Illinois Senate for a plum job with the Illinois Hospital Association only weeks before it hit Gov. Pat Quinn's desk.

It's also disheartening to know that another resident of Illinois, Chicago-based Accretive Health, barely suffered an earnings blip after they agreed to high-tail it out of Minnesota following reports they were strong-arming patients prior to their receiving treatment.

I am cynical, but not everything in the world of hospital finance is necessarily so. For example, it's a much sunnier climate 2,100 miles to the southwest in San Diego--and I mean that metaphorically.

I am referring to an experiment the four-hospital Sharp Healthcare system undertook to try and cover its patients streaming into its emergency rooms. San Diego County has a 17 percent uninsured rate. That's marginally better than California as a whole, but still means 550,000 people without coverage--the combined population of seven of the 10 most populous cities in the county. San Diego also is the largest city in the United States without a public hospital, so there is no site of last resort for the uninsured.

Sharp undertook a pilot project with a company in the Silicon Valley known as PointCare. It installed software in the desktop and tablet computers in Sharp's ERs that allowed staff to perform a quick assessment of patients' insurance status. Patients were asked five quick questions that cover information such as age, size of family, period last insured and whether they belong to specific minority groups, such as Native Americans. More than 32,000 were screened.

The data was then plugged into a program that determines a patient's eligibility for special programs such as Medi-Cal, the state's Medicaid program, a special plan that covers individuals with pre-existing medical conditions, or other options.

The results were eyebrow-raising: 81 percent of the patients screened were eligible for coverage but had not been enrolled. Sharp employees assisted in wading through the paperwork to get them coverage.

As a result, Sharp saved about $5 million on what would previously have been uncompensated or charity care. The survey results also are integrated into the patient's electronic medical records to perform more follow-ups should their coverage lapse and they return to the ER.

The two-month pilot project inevitably stretched to 25 months. The software is now going to be a permanent staple of Sharp's ERs.

PointCare plans to roll out the system to seven more hospital systems over the next several months, officials told me. It will be updated to help enroll patients through their state insurance exchanges when they become operational next fall. Hospitals will be charged a modest monthly fee to use the system.

It's a heartening healthcare finance story at a time when we need as many as we can get. - Ron (@FierceHealth)