Although the United States spends more than $800 billion, or 12 percent of its gross national product, on health care, an estimated 37 million Americans at or below the poverty level experience health risks associated with an inability to afford needed health care (Rowland, Lyons, Salganicoff, & Long, 1994). Between 1980 and 1990 uncompensated care grew from 4.6 percent to 17.8 percent of hospital expenses, reaching nearly $18 billion in revenue deductions and forcing hospitals to re-examine their ability to provide indigent or charity care (Davis & Roland, 1990; Letsch, Lazenby, Levit, & Cowan, 1993). Pursuit of all potential reimbursement options is now a fundamental health care industry fiscal policy. Social workers can be of strategic assistance in facilitating delivery of health care services to needy individuals and contributing to the fiscal bottom line of provider organizations. Although needs assessment and resource provision have long been regarded as integral components of health care social work practice (Becker & Becker, 1986; Bracht, 1978; Cabot, 1909; Cannon, 1923; Holosio & Taylor, 1989; Hubschman, 1983), limited examples of systematic delivery of financial services by hospital-based social workers exist. This article discusses a university hospital program in which the social work department facilitated access to health care for large numbers of needy patients and their families, increased facility reimbursement for services, reduced nonsponsored patient volumes, increased social work visibility, and enhanced the perception of the role social workers have in making patient care and fiscal contributions to the health care provider. The program serves as an operational model and has been adopted by other hospitals. UNMET PATIENT FINANCIAL NEEDS Oregon Health Sciences University (OHSU) is one of the principal teaching, research, and medical care centers in the Northwest, with more than 232,000 patient visits per year. Consistent with most public tertiary health care institutions, a high percentage of patients are either potential or actual Medicaid recipients or nonsponsored private pay (indigent) patients. With government coverage of uncompensated care reaching nearly one-third of OHSU gross patient revenues and growing concerns about maximized reimbursement, accurate patient financial eligibility determinations became crucial. Despite the extensive need, no systematic mechanism existed for providing information and application assistance to OHSU inpatients and outpatients potentially eligible for Medicaid or general assistance. Although the admitting department frequently identified eligible patients to the social work department, time constraints, other patient care needs, and lack of familiarity with complex and ever-changing public assistance program stipulations limited staff response to financial referrals. Such requests were given lower priority than crisis intervention, immediate discharge planning, comprehensive evaluations, counseling, and other interventions perceived as urgent. Relationships with Medicaid agency personnel were limited, updated policies were unavailable, and there was insufficient opportunity to follow through on complex applications. As a result, patients did not receive the detailed, accurate, and timely information they needed to initiate Medicaid applications, and OHSU lost potential reimbursement when discharged patients failed to complete eligibility determination interviews. SOCIAL WORK FINANCIAL ASSISTANCE PROGRAM Recognizing these deficiencies, the social work and admitting departments collaborated on a new rapid, focused intervention to assess patient financial resources, determine potential eligibility for public assistance, provide information about program benefits, assist initiation of applications, and provide follow-through to maximize the likelihood of eligible applicants receiving financial assistance. …
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Sep 26, 2000
Jill B Jones + 1
