Reform Realtime

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Reform Realtime: Why Does it Look like Self-Pay is Rising?

8/8/2014 5:07:35 AM | 0 comments

Yesterday, we reported that the number of self-pay patients has been increasing at our emergency departments (EDs) across the country, and we received a lot questions! Namely, if more people are insured, how can that be the case?

Well as it turns out; there are a couple of factors that made it appear that self-pay is rising.

All of our Reform Realtime data is delayed by a few months because we need to allow the data enough time to mature and become statistically significant. If you think about the amount of time that passes from when a patient first visits an ED to when a claim is finally paid (or denied), it makes sense. On top of that, we do have a large number of newly insured patients who, most likely, are currently categorized as self-pay because their new insurance card hasn’t arrived.

However, despite waiting for several months for the data to mature, that may not be enough time to successfully account for those patients previously thought to be “self-pay.”

A real example of this in play is when patients have their treatment covered by state or local emergency medical funds.

Take California for instance. Years ago, the state legislature created the Emergency Medical Services (EMS) Fund to reimburse emergency medical care for those patients who are unable to pay. Additionally, many cities and counties have similar emergency funds in place for the same reason. The problem with these funds? They frequently run out before the year is over.

More importantly to our case, though, is that it frequently takes up to one year to identify those “self-pay” patients who were, in fact, covered under EMS. This is why we’re seeing this possibly unexpected data when, by all counts, the number of insured patients is on the rise and the number of “self-pay” patients is on the decline.

This is all part of the process of looking at the effects of healthcare reform as they happen! We’re still looking for ways to better capture and analyze the data to accurately reflect the impact of Medicaid expansion and the health exchange products.

Stay tuned in the coming weeks for more analysis from Reform Realtime, including an on the ground perspective by ED nurse managers and a mid-year check-in by Dr. Josh Tamayo-Sarver.

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