A coalition of healthcare providers located in the Southern Tier area of New York State was awarded a HEAL NY grant which provided funds to improve stability, efficiency, and quality of the health care services in the region. Lourdes Hospital is one of the hospitals in the coalition and we were excited to be the pilot site for one of the initiatives. Lourdes, a member of Ascension Health, is a 230 bed hospital located in Binghamton, New York. We have experienced a growing self-pay population with many of the uninsured accessing healthcare through the ED. We did not have an effective approach to screen and assist the low-income uninsured to gain access to government programs. The majority of patients simply left the ED and became bad debt. This pilot program was designed to develop and implement a solution to improve the Medicaid enrollment process in the ED. The intent was to prove the concept in one hospital before deciding to roll out a solution to all members of the Southern Tier Health Link (STHL) coalition.

Our initial goal was to find a technology solution to improve the Medicaid enrollment process. We were seeking a product that provided eligibility criteria for federal, state and local programs for the uninsured. We identified that the ideal technology would provide a rules-based interactive questionnaire for healthcare provider staff to quickly evaluate each patients eligibility for government programs. We then completed an RFP and selected one of the four respondents.

In 2008 we began the pilot and spent considerable time creating a new work flow process that included adding a financial counselor to meet with each uninsured patient immediately prior to discharge. We hired 4 new financial counselors to staff the ED 7 days a week from 8:00am-2:00am. The ED pilot became fully operational on 9/1/08. We collected detailed data to be able to evaluate the effectiveness and cost efficiency of the new process.

Key Findings (Sept 2008-April 2009 data collection)
Uninsured patients were generally receptive to meeting with an ED financial counselor.
During the period, the ED financial counselors completed an interview on 1,791 of the total 2,437 (74%) of the uninsured patients who visited the ED.
Out of the 1,791 patients that were interviewed, the technology projected program eligibility as follows:
o 835 (46.6%) eligible for Govt Programs (i.e.NY Medicaid, FHP,CHP)
o 914 (51.%) eligible for Charity Care (not eligible for NY govt programs)
o 42 (2.4%) not eligible(excess resources and/or assets)
201 of the 835 eligible cases were successfully enrolled with NY DSS.
$358,528 Medicaid Reimbursement YTD for the 201 cases enrolled
$130,362 Direct expenses (Financial counselors salaries and benefits)
The technology proved to be an extremely efficient and accurate tool for conducting the patient program eligibility interviews.
o The interviews were consistently completed in less than five minutes.
o 90%+ accuracy based on subsequent program approvals.

We learned a great deal through this pilot project and have many stories related to what we found helpful and what we needed to change to improve our results.

Overall, we have been very pleased with the results of the pilot. In fact, several months after the ED launch we expanded the program to our primary care network. We have also applied the technology for the Hope Dispensary of the Southern Tier, a program that offers prescription assistance for the uninsured and underinsured. This is a great example of the power of technology and process change to improve revenue cycle results.