The Challenge of Uncompensated Care

John Commins, for HealthLeaders Media , June 18, 2012
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This article appeared in the July 2012 issue of HealthLeaders magazine.

In our annual Industry Survey, only 10% of finance leaders say their organization is "very strong" when it comes to dealing with uncompensated care. Another 37% describe it as "strong," while 53% characterize it as "neutral" or "weak." What accounts for this variation in performance, and what impact do you expect healthcare reform will have on uncompensated care at your organization and the industry as a whole?


Albert White,
Senior Vice President,
Broadlawns Medical Center,
Des Moines, Iowa

How we rate: I always hesitate to say we are super strong, but I think I can put us definitely in the strong category with uncompensated care. We have a community care program where we identify people coming in and we look at 200% of federal poverty and they can qualify for discounted care. We have a sliding scale that goes up to 500%. We do that and we have a lot of good access to financial assistance for these people. We have knowledgeable financial counselors, good people in place.

The challenge met: We have a lot of indigent care. We have now in place an Iowa Care program that collaborates with the state Medicaid department and the University of Iowa hospitals. With that we were able to lower our self-pay percentage to about 20%–25%. At one time just a few years ago we had the highest percent of self-pay in the country, as high as 55% of our patient mix.

The reform impact: Most people anticipate that uncompensated care should go down because there will be more people covered. They aren't going to cover them all. They have admitted that, but maybe 90%–95% will have coverage. There is still going to be uncompensated care. For us we anticipate that we will get our fair share because we are a safety-net hospital. Yes, it will probably decrease but the uncompensated care will still be here.

The shrinking pie: It is unrealistic to think that there is going to be a lot more money thrown into the pool. There has been talk that there will be more funds here because they're going to require people to buy health insurance, or there is going to be some funding for federal programs that will reduce the cost of medical education. But that is just shifting money. It is not generating new funding.

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