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Thursday, Mar 28, 2024
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Sharp Pioneers Patient Eligibility Process

In a fractured health care market, hospitals struggle to find ways to recoup the heavy costs of treating the uninsured. But San Diego’s Sharp HealthCare has pioneered a simple approach to increase its rate of insurance reimbursements, resulting in $5 million regained — through a 90-second quiz.

The health system has partnered with San Mateo-based PointCare Inc. to develop the five-question eligibility quiz for patients, and conducted a 25-month study in its four busy emergency rooms around San Diego to determine its effectiveness. And it’s been successful — Sharp found that about 80 percent of its uninsured emergency room patients were actually eligible for some variety of coverage.

“The PointCare program opened a dialogue with our patients about their financial options, and we’ve seen a pretty significant increase in our patient cash collections ever since,” said Gerilynn Sevenikar, vice president of patient financial services at Sharp HealthCare.

Based on the outcomes seen at Sharp, a new hospital system has adopted the PointCare system. The Community Health Alliance of Pasadena, a Los Angeles-area community health center, has signed on to use the new system.

A study from the U.S. Department of Health and Human Services found the unpaid tab to hospitals caring for uninsured patients was $49 billion annually.

Sevenikar said that reimbursements have improved year-over-year by about three to six percent, amounting in the $5 million bottom line.

‘Important Financial Strategy’

“Any program that can help hospitals recoup costs while providing coverage to previously uninsured patients is indeed an important financial strategy,” said Steven Escoboza, president and CEO of the Hospital Association of San Diego and Imperial Counties. “It’s a win-win for all concerned.”

In 2009, Sharp noticed a decline in self-pay patient collections coupled with an increase in self-pay account volume — coinciding with a steep rise in unemployment in San Diego County.

“Sharp wasn’t unique with its dilemma — since the recession, hospitals around the country have been dealing with increasing care costs for the uninsured and less revenue from self-payers,” said Phil Lebherz, CEO of PointCare. “Sharp was looking for a solution to this issue, and was innovative enough to let us experiment with their uninsured patients by using PointCare.”

The program was so successful that the quiz has now been integrated into the hospital’s emergency department routine, Sevenikar said. It incorporated Sharp’s coverage and enrollment data with its existing protocols and financial systems — which resulted in every patient learning his or her coverage options before leaving the emergency department.

That’s because Sharp found the vast majority of the patients who took the survey were not enrolled in free or low-cost government programs for which they were actually eligible. Many of these patients would otherwise have merely received treatment, then walked away without paying the costly emergency room bill, Sevenikar said.

Laborious Qualifying Process

“Most self-pay patients want to contribute toward their bill, but because of the laborious nature of qualifying for assistance on both the patient’s and the hospital’s end, they often give up and leave the hospital unfunded,” she said.

In the 25-month measurement period of the survey, about 42,000 uninsured patients participated. The study found that 80.6 percent of patients were eligible for different public health programs at the state and federal level, such as Medi-Cal and Healthy Families. About 16.6 percent were eligible for individual group coverage or COBRA, and 2.8 percent were eligible for a high risk pool program, such as the federally implemented Pre-Existing Condition Insurance Plan.

PointCare was actually formed in September 2012 as a direct result of the success of the Sharp program. Sharp previously was working with the non-profit Foundation for Health Care Education, which launched a site called CoverageForAll.org that offers the same quiz to anyone willing to take it.

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