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    Help uninsured patients without hurting your practice

    Physicians may increasingly face the predicament of wanting to provide care for patients in need while also needing to protect their practice finances. 


    IN CASE YOU MISSED IT: 9 ways to combat physician suicide


    According to Gallup data, the percentage of Americans without health insurance is on the rise—up from its historic low of 10.9 percent in 2016 to 12.2 percent at the end of 2017. And with the passage of a tax bill that eliminates the individual mandate of the
    Affordable Care Act, the upward trend likely will continue in the coming years. 

    For some practices, the challenges are already significant. “There are a lot of practices across the country that have unfortunately not been able to maintain their viability because they’re taking care of people without the ability to pay,” says John Cullen, MD, a primary care physician in Valdez, Alaska.

    His four-doctor practice discounts care for several patients per week. Most of the indigent care is written off by the practice as charity care, he says.

    “It’s really hard on you as a physician when somebody has a desperate need and just can’t pay. If somebody needs surgery and can’t afford it, it just tears you up,” he says. 

    There isn’t much alternative, however, considering that the only other healthcare provider in the community is the hospital. And the same doctors who practice at Valdez Medical Clinic, LLC, cover the emergency department.

    “When you’re looking at large populations, it’s much easier to talk about how much things cost,” Cullen says. “But when you’re looking at an individual who is in your office who just can’t afford something, it’s not as easy to be really strict about it.”

    A primary care practice’s willingness to accommodate patients who lack insurance or ability to pay is consistent with the American College of Physicians’ (ACP) Ethics Manual, which states, “all physicians should provide services to uninsured and underinsured persons.” 

    However, practices often make a distinction between established patients who lose their insurance coverage and uninsured patients who are new to their practice.

    “It’s not very common for a patient who has no coverage and no means to pay for their care to call us for an appointment to establish care,” says Yul Ejnes, MD, MACP, an internist and past president of the ACP Board of Regents. In these rare instances, he says he would handle it on a case-by-case basis.

    With the potential for more uninsured patients to begin seeking care throughout the country, however, practices can take a variety of steps to be better prepared.

    Eligibility checking

    For starters, patients who lose insurance may not be forthcoming about, or even aware of,  a change in their coverage status. Therefore, practices need solid eligibility-checking procedures to avoid the potentially awkward situation of having to confront patients after their claims have been denied, says Laurie Morgan, a partner with practice management consultancy Capko & Morgan.

    “Re-verifying the patient’s eligibility when the patient books an appointment—and again before the service—can help prevent accidentally seeing a patient whose insurance no longer applies,” she says. Most practice management systems now allow practices to verify a patient’s insurance eligibility in real time, she adds.


    FURTHER READING: How the new budget deal affects physicians


    If a practice finds during this process that a patient lacks coverage, the practice can offer to treat the patient on a cash basis. But if the practice chooses to terminate its relationship with the patient, it’s important that the practice take precautions (e.g., providing reasonable notice), to avoid allegations of patient abandonment, which could bring a  malpractice lawsuit.

    Next: Setting rates and understanding restrictions


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