Some hospitals are using ED visits as a way to help uninsured patients obtain health coverage, whether through the Affordable Care Act's health insurance exchanges or through expanded Medicaid options.
Hospitals and other providers are motivated to help uninsured patients sign up for coverage because those who qualify for subsidized, private coverage through the exchanges will help boost revenue and reduce bad debt as hospitals deal with deeper Medicare cuts, according to Kaiser Health News/NPR. And for those who qualify for Medicaid, hospitals can get paid retroactively for treatments going as far back as three months.
"I think the [ED] waiting room is one of those places where you have low-hanging fruit," explains Renee Hsai, an associate professor of emergency medicine at the University of California-San Francisco. These patients are not "the sickest of the sick because at least someone, the triage nurse, has deemed them stable enough to wait. And if they're waiting, they might as well be filling out some application form, or at least learning about the process."
How one ED is making the insurance pitch
Using funding from California's health insurance exchange, O'Connor Hospital in San Jose has opened the Health Benefits Resource Center down the hall from its ED, which sees about 5,000 uninsured patients per year. At the center, Araceli Martinez's is tasked with helping patients obtain insurance.
At the end of an ED visit, patients are given financial packets and a phone number to call to go over options. Before 2014, uninsured patients had few options when it came to paying hefty ED bills. Now "they're saying…'Well, maybe I afford [some coverage],'" Martinez says. About seven in 10 patients who speak with Martinez follow up and obtain coverage.
CEO Jim Dover says the enrollment efforts are not about revenue. Rather, he hopes they will discourage patients from using the ED for common ailments.
"Let me use this metaphor: A person is coming down the river, and they're drowning, and you jump in and pull them out. And then they come down again, and you pull them out," Dover says, adding, "At some point, you have to go up the river and take care of the spot where they're all falling in" (Varney, Kaiser Health News/NPR, 1/14).
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