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Tag: Uninsured

COVID-19 UNCOMPENSATED CARE RECOGNITION SERVICES – Hospital Financial Assistance Policy Update

Hospitals should ensure Financial Assistance Policy language reflects ALL forms of charity discounts.

Hospital Patient Financial Assistance Policy
As the healthcare industry prepares for COVID-19, hospitals may experience high volumes of care to the most critically vulnerable population of underinsured and uninsured patients.  CMS only recognizes, and reimburses, for this charity if it is articulated in the hospital’s patient financial assistance policy (FAP).  Toyon recommends hospital teams verify language in the FAP to be reflective of all forms of charity discounts under Medicare definitions.  

What should generally be in an FAP as Charity
Hospital patient financial assistance policies should not only specify charity care discounts as patient financial assistance, but also self-pay discounts (not related to prompt pay) and non-covered Medicaid as forms of charity care. 

Access to Healthcare Crisis FAP Language
In preparation for what could be an extraordinary demand on the healthcare system, Toyon has crafted the FAP language below.  This is draft template language to assist our clients.  Any language adopted by a hospital should follow the hospital’s approval procedure (approved by hospital leadership / board of directors). 

An Access to Healthcare Crisis must be proclaimed by [hospital leadership / approved by the board of directors] and attached to this patient financial assistance document as an addendum.  An Access to Healthcare Crisis may be related to an emergent situation whereby state / federal regulations are modified to meet the immediate healthcare needs of the hospital’s community during the Access to Healthcare Crisis.  During an Access to Healthcare Crisis [hospital / health system name] may “flex” it’s patient financial assistance policy to meet the needs of the community in crisis.  These changes will be included in the patient financial assistance policy as included as an addendum.  Patient discounts related to an Access to Healthcare Crisis may be provided at the time of the crisis, regardless of the date of this policy (as hospital leadership may not be able to react quickly enough to update policy language in order to meet more pressing needs during the Access to Healthcare Crisis).  

Please contact Fred Fisher at 888.514.9312, with any questions. 


Toyon Associates, Inc.

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Number of Uninsured Projected to Decrease, Faster Health Expenditure Growth Expected as Coverage Expands and the Economy Improves, CMS Actuary Reports

From: CMS Newsroom Press Release – 9/3/14

The number of uninsured is expected to decline by nearly half from 45 million in 2012 to 23 million by 2023 as a result of the coverage expansions associated with the Affordable Care Act, according to a report from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary.  The report is being published today in Health Affairs.

“Health care costs are increasing at a slower rate thanks to the Affordable Care Act,” said Marilyn Tavenner, CMS administrator. “The dramatic decrease in the number of uninsured Americans is a win for our country and its economy in the future.”

Health spending growth for 2013 is projected to remain slow at 3.6 percent, which would mark the fifth consecutive year of spending growth under 4.0 percent.  National health expenditures (NHE) are projected to grow at an average rate of 5.7 percent for 2013 through 2023, about 1.1 percentage points faster than the expected average annual growth rate for the Gross Domestic Product (GDP).  

Average annual growth of 6.0 percent per year is projected for 2015 through 2023, largely as a result of the continued implementation of the Affordable Care Act coverage expansions, faster projected economic growth, and the aging of the population.  While projected growth over the projection period is faster compared to recent experience, it is still slower than the growth observed over the last two decades. From 1990-2008, the average rate was 7.2 percent and health spending grew 2 percentage points faster than GDP.  

The National Health Expenditure projections report, issued annually, contains estimates of spending for health care in the U.S. over the next decade by type of service and source of funding.

Other Findings:

2014 Spending Growth Expected to Accelerate. For 2014, the health spending growth rate is expected to be 5.6 percent, as 9 million Americans are projected to gain health insurance coverage, predominantly through Medicaid or the Health Insurance Marketplaces.  Out-of-pocket spending is projected to decline by 0.2 percent.

Government Health Expenditures Expected to Increase. By 2023, health expenditures financed by Federal, State, and local governments are projected to account for 48 percent of national health spending.  In 2012, such expenditures constituted 44 percent of national health spending.

Number of Uninsured Projected to Decrease, Faster Health Expenditure Growth Expected as Coverage Expands and the Economy Improves, CMS Actuary Reports

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Safety Net Hospitals Already Seeing More Paying Patients — And Revenue

From: Kaiser Health News – 5/27/14

Article Excerpt:

At Seattle’s largest safety-net hospital, the proportion of uninsured patients fell from 12 percent last year to an unprecedented low of 2 percent this spring—a drop expected to boost Harborview Medical Center’s revenue by $20 million this year.

And the share of uninsured patients was cut roughly in half this year at two other major safety net hospitals—Denver Health in Colorado and the University of Arkansas for Medical Sciences Hospital (UAMS) in Little Rock, Ark.

One of the biggest beneficiaries of the health law’s expansion of coverage to more than 13 million people this year has been the nation’s safety-net hospitals, which treat a disproportionate share of poor and uninsured people and therefore face billions of dollars in unpaid bills.

Such facilities had expected to see a drop in uninsured patients seeking treatment, but the change has been faster and deeper than most anticipated— at least in the 25 states that expanded Medicaid in January, according to interviews with safety-net hospital officials across the country. 

 “This is really phenomenal,” said Ellen Kugler, executive director of the National Association of Urban Hospitals, based in Sterling, Va., which represents inner-city safety net institutions. “It shows the Affordable Care Act is clearly working in these locations.”

Safety net hospitals, most of which are government-owned or nonprofit, have typically struggled financially because their urban locations mean they treat more uninsured patients who show up in emergency rooms and cannot be turned away.  

Read more…

Safety Net Hospitals Already Seeing More Paying Patients — And Revenue

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