The financial impact of the pandemic on hospitals has been enormous. Patients can’t pay their high medical COVID-19 bills and hospitals don’t get paid for their care and treatment they provided. In this guest post, Ethan Davidoff, founder & CEO of a company that helps providers and payers leverage medical financial aid programs so vulnerable patients can access and afford care, explains what hospitals should look for in a platform that’s right for their facilities.
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As the full impact of the COVID-19 pandemic continues to unfold, CEOs, CFOs and senior level management at health systems face increased pressure to recover lost revenues while providing the maximum level of financial assistance for their uninsured and underinsured patients. The American Hospital Association (AHA) estimates a total four-month financial impact of $202.6 billion in losses for America’s hospitals and health systems, or an average of $50.7 billion per month, due to the COVID-19 pandemic.
Despite the availability of 10,000+ sources of medical financial aid to resolve these issues – including coverage for COVID-19 related treatments – health systems are often mired in obsolete legacy methods of identifying these resources, engaging and enrolling patients, and managing the claims reimbursement process across the system.
As more health systems strive to help patients access and afford the care they need, they should look to adopt innovative technology and service solutions to accelerate the rate at which they secure medical financial aid reimbursement for all eligible patients. The right solution will address and resolve three key challenges.
Medical financial aid complexities
More than 10,000 medical financial aid programs exist to fund $75 billion of patient care, and the volume of programs and funding is expanding every year. Philanthropy often finances capital and clinical programs. In fact, $427 billion in charitable contributions went to U.S. not-for-profit organizations in 2018, with almost $40 billion of that for health causes.
More than 70 million uninsured and underinsured patients qualify for medical financial aid programs, but most don’t take advantage of them, leading to health systems losing at least $41 billion per year because patients can’t afford the bills.
Regrettably, patient advocates at many health systems don’t have access to the data, process automation or the time to effectively identify, enroll and capture reimbursement opportunities on behalf of all uninsured and underinsured patients that need help.
Solution: The right medical financial aid platform can help health systems tap into as many medical financial aid programs as possible and enroll patients as quickly as possible. Look for a solution that automatically matches patients with all programs they may qualify for based on their diagnosis, treatments, prescribed medications, insurance coverage, claims status, financial situation and a variety of other factors.
In order to access these untapped opportunities, the solution should employ advanced automation to transform the complex process of medical financial aid matching, enrollment and reimbursement into a simple workflow that identifies a greater number of coverage opportunities, creating the right financial plan for each patient. This simplifies a health system’s ability to gain additional cash and inventory for operational needs.
Uncoordinated aid efforts
Capturing all medical financial aid opportunities requires collaboration and teamwork across registration, nursing, pre-certification, patient advocacy, pharmacy and billing. It’s common that different programs may be managed by different departments in the health system, which can present workflow challenges, data silos and missed opportunities. As a result, medical financial aid opportunities are missed, and the health system is unable to develop a holistic financial aid plan to support the patient.
Solution: The right medical financial aid platform unifies separate medical financial aid efforts across departments under one centralized and coordinated platform. Individual departments are then better able to drive cross-functional efficiencies and dramatically improve patient satisfaction and HCAP scores.
COVID-19 reimbursement issues
Health systems and patients are facing reimbursement challenges related to high, unexpected medical bills and out-of-pocket expenses associated with COVID-19. A federal program was meant to cover testing and treatment for uninsured people with COVID-19, using funds from the federal coronavirus relief package. Instead, large numbers of patients with other serious medical conditions have been disqualified because COVID-19 must be the primary diagnosis. At one hospital in Miami, for example, only 60% of uninsured COVID-19 patients were covered under the new legislation.
Because of the pandemic, 43% of working-age adults had no stable insurance in the first half of 2020, leaving many with highly publicized surprise bills for COVID-related care – and many others hesitant to get care for fear of medical bills they can’t afford. In addition, even patients who do have coverage might delay treatment during the pandemic because they are wary of the effectiveness of the COVID-related safety policies meant to reduce their risk when in a healthcare setting.
With recent COVID-related pressures, health systems are striving to regain trust, enhance their relationships with the communities they serve and reestablish themselves as true community partners.
Solution: The right medical financial aid platform ensures that patients get access to the care they need, regardless of income level – without surprise medical bills – enabling them to focus on their health and not financial stress. Once the right solution is implemented, it’s also critical that health systems make their communities aware of their medical financial aid efforts so patients know they can seek the care they need without fear of insurmountable medical debt.
Look for a solution that specifically offers a COVID-19 financial aid program, in addition to ongoing programs that support uninsured and underinsured populations. Health systems can leverage technology to save time in identifying HRSA-eligible reimbursement claims and reduce submission errors.
The COVID-19 pandemic has exacerbated the longstanding challenges health systems face in optimizing medical financial aid programs in a way that benefits all stakeholders. The magnified need for technology and services that accomplish this goal give health system leadership the opportunity to act on a project that’s often not prioritized at a system-wide level. Leaders who prioritize medical financial aid at this critical time can establish a long-term program that will reinforce their mission to support their communities, while recovering lost cash and inventory associated with uncompensated care. Ultimately, this will increase patient satisfaction and referrals, improve operating margins and achieve higher levels of compliance.
With over 10 years of healthcare, enterprise software, and cyber security experience, Ethan Davidoff founded Atlas Health in 2017 and maintains the role of CEO.
