One Major Administrative Hassle Many Hospitals Will Have to Deal with Thanks to HIEs

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HCR-thumb5With the health insurance exchanges finally going live this week, some of the kinks in the system have been exposed, but the fundamental principle of the HIE remains in place: creating a marketplace in which people can shop for the best and most affordable insurance plan for them.

Sounds good. Sound great. But what about the hospital or the clinic or the physician practice that has to keep track of all of those different insurance options?

Take southwestern Pennsylvania physicians, Steve Twedt of the Pittsburgh Post-Gazette writes. “New customers to the health insurance marketplace in southwestern Pennsylvania will have more than 35 different plans to choose from. And physicians who treat those patients may have no choice but to keep track of all 35 plans — each with its own coverages, co-payments, and deductibles.”

Cardiologist C. Richard Schott, president of the Pennsylvania Medical Society, said, “It’s going to be very confusing to the patient and to the physicians… We are getting a lot of questions [from physicians] about how to deal with the volume of patients. We have gotten very little or no information from most of the insurance companies.”

On top of this administrative hassle, there are others, such as “how many patients will seek care once they have insurance…what level of care they will need and what happens if patients with high-deductible plans can’t pay their bills,” Twedt writes. Will those who haven’t had access to healthcare for years storm the hospital barricades in search of that care? Which kinds of illnesses and physical ailments will they bring with them? How will these ailments strain the practice or hospital?

Donna Kell, chief executive officer of Kell Group, a medical billing organization, “acknowledged…that with the multitude of different plans, there ‘absolutely’ will be a greater administrative burden on physician practices to determine a patient’s eligibility and benefits ahead of time. And, even if the physician practices get their part right, it doesn’t mean the claim will be handled correctly.”

She observed, “I don’t have a high level of confidence that the insurance plans are going to adjudicate it properly. They may not have the number of people to handle it, or they may not have the number of people who are educated [on the different plans]. There’s going to be a lot of variation.”

As healthcare executives, how are you planning to manage the multiple different insurance plans that newly insured patients will be bringing your way? Is this situation as complicated in your state as it seems to be in Pennsylvania? What could be done to make this administrative headache more efficient for healthcare organizations across the country?

-by Pete Fernbaugh

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