Financial Counseling

Strategies to Assist Uninsured Patients

April 18, 2017 8:49 am

Wooster Community Hospital’s initial efforts to help uninsured patients gain coverage reduced bad debt enough to produce funds to hire a full-time employee who could continue to focus on patient financial assistance.

Wooster Community Hospital (WCH) serves Wooster, Ohio, a town of about 26,000 people located in northeastern Ohio. Although the unemployment rate is low, the city’s average household income of $42,825 is lower than Ohio’s average household income of $51,000, and 19 percent of its residents have incomes below the poverty level, which sometimes makes it difficult for patients to meet their healthcare financial responsibilities. Wooster also serves an Amish community whose members often pay for care through church-sponsored funds rather than purchasing traditional insurance, so they value prompt-pay discounts and package pricing.

In an interview with Revenue Cycle Strategist, Kristen Shoup, director of revenue cycle for WCH Health System, discusses how the hospital helps its uninsured patients enroll in Medicaid or set up payment plans for services.

How does your package pricing program help uninsured patients?

We do a lot of package pricing for services such as OB [obstetrics] deliveries, surgeries, and imaging studies. Self-pay patients or patients with high deductibles can make payments on services that will cover all healthcare providers who are involved in their care.

Patients like package pricing because it is one bill, and they know exactly what they are going to pay before they have the services. The Amish community that uses our services does have a kind of insurance; they pool their money as a community and have a fund administrator, but generally infant deliveries are not covered by the pool, so the patients have to pay for that care on their own. The ability to spread those payments out over the course of the pregnancy makes it a bit easier for Amish and non-Amish patients to fulfill those financial obligations.

What types of patients are likely to be uninsured?

The uninsured exist across the general population, so our goal is to determine if they qualify for coverage. For example, for OB patients who don’t have insurance, the first thing we do is determine whether they are eligible for Medicaid. We want pregnant women to get prenatal care so they have healthy babies. In Ohio, pregnant women qualify for Medicaid at significantly higher income levels than other Ohio residents.

We work with our uninsured patients to help them apply for financial assistance or Medicaid. We visit patients in the room once they have been admitted or prior to a surgery, and we have extended that service to our OB patients in our physician practices.

My staff is also trained to assist patients with the application process. In addition, my staff can designate themselves as representatives on patient applications, which means they will receive county notices about each application’s progress and any deficiencies that need to be rectified.

Is it common for hospitals to reach out to uninsured patients at the beginning of their care?

I think a lot of the bigger hospitals were earlier to the game than we were. Some hospitals hire outside vendors to handle the patient outreach, but it didn’t work well for us because we didn’t have a good process for referring patients to the vendor. Instead, we hired a dedicated staff person to work with this population to gain medical coverage at the beginning of their care process.

How much money were you writing off as bad debt before the hospital started reaching out to uninsured patients?

It was significant. It was enough that if we could capture a quarter of that amount, I could pay for a full-time employee to focus on uninsured patient outreach.

People value healthcare services most before they receive them. If we can capture them prior to service or at the moment of service, we have a much higher likelihood of getting their cooperation in applying for Medicaid or applying for charity care.

We have evolved over the years. Counselors look at our surgery schedules a week or so out to check for patients without insurance. We contact them and ask, “Do you have insurance? Here’s what we estimate your charges are going to be. How do you plan to meet this financial obligation? Can we talk to you about financial assistance? Can we help you apply for Medicaid?”

We provide estimates for people with insurance, too, so we can prepare them for what their out of pocket is going to be, collect that up front at the time of service, and offer them a little discount if they can pay up front. We create the expectation of payment for those who can pay and for those who can’t pay, we figure out plans for how they are going to meet their obligations.

The more we can do up front to help people understand what their financial obligations are going to be, the better off everyone is. It is better for patients because there are fewer surprises. They can make informed decisions. If it is something elective, patients can ask themselves, “Do I value this service enough to pay this much money for it?” It’s not a fun conversation to have with folks after they have already had the service, and now they owe thousands of dollars, and they had no idea.

What lessons have been learned throughout the years?

It is an ongoing learning process. What is simple to me isn’t always straightforward and clear to the person with whom we are trying to communicate.

We are constantly improving the way we are communicating the program to physician offices and patients and how we capture information. For example, we hired an Amish liaison to work directly with our Amish community, and we developed an outreach program with physician office staff to educate them about the package pricing availability and financial assistance options. We also advertise our package pricing in print ads seen by the community, post it on our website, and have signage in the hospital alerting patients to its availability. A front-page article in our local paper featuring an interview with our Amish liaison also helped promote our package pricing options.

Package pricing started several years ago with one group practice and a handful of services, and it has grown to a whole spectrum of services. It’s become a known commodity, at least in the Amish community. If they know they are going to require a service, and we don’t have it on our menu of package pricing, they ask us if we can develop a package price.

How many patients choose package pricing?

Our package prices are a small percentage of our overall business, probably less than 1 percent, but they have doubled in volume over the past two or three years.

This year, I set up a database for my staff who handle the back-end process of distributing payments for various providers, so we can capture that data. For example, we capture what healthcare services are being taken advantage of and by whom so we can monitor successful service lines and identify those we want to grow through focused efforts and communication.

Interviewed for this article:

Kristen Shoup, RHIA, CHFP, is director of revenue cycle for WCH Health System and a member of HFMA’s Northeast Ohio Chapter.


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