North Shore LIJ Health System (NSLIJ) and TransUnion Healthcare in a joint study identified that when out-of-pocket medical expenses exceed 3.5 percent of a family's annual gross income for NSLIJ's patient population, the ability for the patient to pay declines dramatically. This study comes as both patients and hospitals struggle to remain out of the red in managing healthcare debt.
"Affordability has become a major concern as out-of-pocket spending for the uninsured and healthcare cost sharing, such as premiums, deductibles and co-pays, has increased at much higher rates than families' incomes," said Bob LeWinter, vice president at North Shore LIJ Health System. "North Shore LIJ believed that it could expand its charity care criteria to be more inclusive by adding a new analytic threshold into its identification processes that analyzes out-of-pocket medical expenses as a percentage of family income."
By incorporating another analytic into its charity care identification processes, North Shore LIJ looked to achieve the following:
- Build more effective strategies for follow-up on patient accounts with outstanding balances.
- Locate a new group of potentially eligible charity care patients.
- Strengthen the data and analytics used to designate accounts for presumptive charity care when patients have not responded to billing and collection efforts.
"We've been able to add a third dimension to our charity care identification process that identifies the tipping point when out-of-pocket medical expenses as a percentage of income place too great a financial strain on families," said LeWinter. "When we received the study results back, it was clear there was a percentage point where recoveries leveled off, which was 3.5 percent. Because the results were so compelling, we wanted to take the best from both analytic worlds. So by adding the financial hardship metric to the existing analytics of family size and income, we now have tremendous confidence that we're assigning charity care in the right place and to the right patient."
TransUnion Healthcare solutions provide instantaneous data and analytics at the point of need, enabling healthcare providers to move critical decision making to the front-end of the revenue cycle process in an effort to increase reimbursements and reduce bad debt expense. TransUnion is able to deliver patient level financial information necessary to customize a collection or financial assistance program that is mutually beneficial for the healthcare provider and the patient. By proactively assessing a patient's ability to pay and likelihood of financial aid at point of service, TransUnion's solutions help improve cash collections, segment accounts into the appropriate payment workflows, and provide greater transparency for improved patient satisfaction.
"North Shore LIJ's research was prompted by a concern that potentially thousands of patients eligible for financial assistance programs were not being identified at the front-end of the process. NSLIJ has now strengthened both its collection and charity care identification processes by introducing a new financial hardship metric. Incorporating this critical tipping point will enable NSLIJ to identify more patients for financial assistance, and do so earlier in the revenue cycle," said Milton Silva-Craig, executive vice president of TransUnion Healthcare. "As a result, they will achieve a more efficient adjudication process and reduce dollars spent on collections and financial assistance efforts."
Silva-Craig added, "When hospitals don't have the most up to date information on a patient's ability to pay, unreimbursed costs can end up moving through the entire revenue cycle unnecessarily before potentially being reclassified as charity care only after considerable time, effort and dollars. That's why health systems like North Shore LIJ are proactively using this data intelligence to make smarter decisions and create greater efficiencies within the revenue cycle process."
For access to the full study entitled "Healthcare Financial Hardship Limits" please click here.
About North Shore-LIJ Health System
The nation's second-largest, non-profit, secular healthcare system, North Shore-LIJ delivers world-class clinical care throughout the New York metropolitan area, pioneering research at The Feinstein Institute for Medical Research and a visionary approach to medical education, highlighted by the Hofstra North Shore-LIJ School of Medicine. The winner of the National Quality Forum's 2010 National Quality Healthcare Award, North Shore-LIJ cares for people at every stage of life at 15 hospitals, long-term care facilities and more than 200 ambulatory care centers throughout the region. North Shore-LIJ's owned hospitals and long-term care facilities house about 5,600 beds, employ more than 10,000 nurses and have affiliations with more than 9,000 physicians. Its workforce of about 42,000 is the largest on Long Island and the ninth-largest in New York City. For more information, go to www.northshorelij.com.
About TransUnion Healthcare
TransUnion Healthcare, a wholly owned subsidiary of credit and information management company TransUnion, empowers providers and payers with instantaneous intelligence by providing data and analytics at the point of need. In the provider market, TransUnion offers a series of data solutions designed to move critical decision making to the front-end of the revenue cycle process. In the payer market, TransUnion offers healthcare analytics and reporting solutions to help payers meet their reporting needs, control costs and improve the overall health of their members.
As a global leader in credit information and information management services, TransUnion creates economic and competitive advantages for businesses and consumers. For businesses, TransUnion helps improve efficiency, manage risk, reduce costs and increase revenue by delivering comprehensive solutions that leverage data, advanced analytics and decisioning technology. For consumers, TransUnion provides the tools, resources and education to help manage their credit health and achieve their financial goals. Through these and other efforts, TransUnion is working to build stronger economies worldwide. Founded in 1968 and headquartered in Chicago, TransUnion employs associates in more than 25 countries on five continents.