"Had we done nothing, I would've expected our self-pay to decline or stay flat," she says. FCHE has done similar work with Catholic Healthcare West and the Daughters of Charity Health System in California, and is a referral resource for patients who contact the American Cancer Society, the American Diabetes Association, the American Lung Association, and the American Heart Association seeking assistance
Lebherz says what's happening now is great, but a real revolution will occur if agencies begin to allow point-of-care enrollment in public assistance programs. Though it's a nonprofit, FHCE is considering making the software available to hospitals. The software will allow hospitals to assess eligibility through a predictive-modeling structure at the point of care, improve work flow efficiencies by identifying all health coverage options available, and interfacing in a cloud delivery model with the hospital's electronic medical record system.
Self-pay as your profit margin
Hospitals and health systems, generally, operate on such thin margins that a small percentage of revenue either way makes the different between profit and loss on an annual basis. Given Sharp's example, and that of countless other hospitals nationwide, getting coverage for the uninsured can mean the difference between a year in the red or in the black.
T. Ulrich Brechbühl, CEO of Chamberlin Edmonds, now part of Emdeon, and senior vice president of Emdeon Revenue Cycle Solutions, says the number of uninsured has grown in the United States by about 15%–18% since 2008. Chamberlin Edmonds, an Atlanta-based for-profit company, has helped hospitals with eligibility services for the uninsured for 25 years. It focuses on optimizing institutions' eligibility and enrollment activities without creating a burden on public agencies, as Brechbühl says many of them are dealing with a huge workload due to the increase in outpatient assistance requests.
For example, he says, the average outpatient visit is only worth a fraction of the inpatient visit.
"If the average inpatient reimbursement is $20,000, the average outpatient reimbursement is less than $1,000," he says. "All these applications get submitted to the same agencies. The problem becomes when you flood the agencies with a bunch of low-dollar visits, the agency is obligated to process them in order."
That can be a problem for a hospital looking to maximize its return on investment for patient eligibility work, especially with the dramatic increase in outpatient demand, he says, adding that five years ago, less than half the patients referred to his company for eligibility work were outpatient based. Now, he says, it's two to one in favor of outpatient, yet the payment disparity obviously remains.