The HIE Conundrum: Patient Liability and Payer Education (Part 3 of 4)

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HRF-thumb3We’ve been looking at the impact that health insurance exchanges (HIEs) are expected to have on a hospital’s revenue cycle, as detailed by Rene Letourneau in the June issue of HealthLeaders magazine. So far, we’ve discussed bad debt and cost sharing in relation to patient participation in the exchanges.

Now, let’s turn our attention to another complex element of HIEs: whether or not the uninsured patients understand their liability under the exchanges.

It’s important to remember, Letourneau points out, that “most [patients] will be moving off of state-run insurance initiatives that generally have no or low premiums and copays.” Stephen Forney, vice president and chief financial officer at Albuquerque-based Lovelace Health System, observes, “These initiatives are going to be subsumed by the exchanges, and the new products are going to have significant patient liability and premiums. That is going to be a bit of a sticker shock for those individuals who have not been used to that in the past.”

This patient population, he added, is used to receiving care through the emergency department. Under reform, this care will largely be provided in nonacute settings. “When the doctor refers them to the hospital for a CAT scan or a procedure, they probably won’t have the ability to pay for that out of pocket. It will diminish some uncompensated care in the ER and shift it to other sites. …In a sense, what you are going to do is encourage utilization in nonacute sites by patients who can’t pay the patient-liability portion.”

Lovelace is, therefore, seeking to educate its patient population on exchange products, “so that they understand how their products work and what it means to them before they get to our door so people can adjust and adapt.” This outreach campaign “will include printed materials, website postings, advertisements, and educational seminars.”

“We are trying to anticipate what it will mean to the revenue cycle and how we can best integrate those individuals. … We’ll be doing a lot of education with this newly insured population so that they understand how their products work and what it means to them before they get to our door so people can adjust and adapt,” Forney added.

Will your newly insured patients fully understand their liability under the exchanges? Have you pursued any educational initiatives designed to help them understand the new system of care?

In our next post, we’ll look at our fourth and final complexity in the HIE Conundrum: the political one.

-by Pete Fernbaugh

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