Notice the secondary finding of post–Medicaid expansion: Self-pay patient collections can be “less” than your practice’s prior self-pay collections. These are most likely your true self-pay patients—your residual self-pay patients who have not been absorbed into a Medicaid plan. Of related importance, however, is that Dussault et al reported early evidence that Medicaid expansion is fulfilling the goal of health insurance providing “peace of mind” by protecting against financial hardship.5 This certainly bodes well for patient experience-of-care scores.
Examine the Details
When looking at the connected dots thus far, it brings into focus the incredible significance of staying centered on your patient’s clinical presentation, coupled with the necessity of being supported by a business partner equipped with the latest analytical tools to efficiently drill down into the patient demographics and propensity-to-pay metrics. It also highlights the absolute necessity that the ED registration staff obtains accurate and current patient demographic information.
Law describes the pertinent industry patient transitions this way: “We’ve transitioned this business, which used to be a physician-to-carrier relationship, into a physician-to-patient or -consumer relationship.”6 He cites the necessity of developing clear images and metrics of patient and payer personas using various propensity-to-pay and propensity-for-friction metrics as critical today in successfully collecting physician revenue.
At a true nuts-and-bolts level, this involves careful scrutiny of patient information to understand patients’ tendencies and proclivities to pay for your services. It culminates in the development of patient protocols and best practices for patient contact and engagement. Butcher additionally describes linking clinical diagnostic data elements to define patient groupings to develop more refined and better care delivery as we migrate toward population health care models.7
Why is it important?
Patient financial responsibility for medical care continues to rise. The Kaiser Family Foundation reported in 2015 that “since 2010, deductibles for all workers have risen almost three times as fast as premiums and about seven times as fast as wages and inflation.”8 Additionally, the just-released Milliman Medical Index report notes that “the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $25,826.”9
It will be an ongoing challenge to anticipate the dynamics of the continually evolving emergency patient who must first receive quality care, resulting in high experience-of-care scores. Additionally, your business partner must be technically skilled to uncover the metrics that will predict and result in the best financial outcomes for your practice.
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One Response to “How Today’s Paying Emergency Department Patients Are Changing”
August 7, 2016
Myles Riner MDAlthough Medicaid coverage for patients generates more revenue than uninsured patients, Medicaid patients are more likely to use the ED once they have coverage. You have to also consider how many more provider hours are required to provide these additional services, and Medicaid rarely pays enough in most States to cover these costs. Thus the overall effect on hospital and EP group revenues net of costs may be NEGATIVE, especially in areas where Medicaid coverage is not matched by access to primary and urgent care services for Medicaid patients. We hear lots of stories about revenue increases for hospitals when States increase Medicaid coverage, but very little or nothing about the sufficiency of these revenues when it comes to meeting the increased demand on EP services.