Proactive approach identifies benefits
April 1, 2012 3 minutes read
Proactive approach identifies benefits
Patients are targeted early in their stay
Faced with an increasing number of patients who have no insurance and can't afford to pay for their own care, the University of Iowa Hospitals and Clinics in Iowa City, has developed a multi-pronged approach to identify indigent patients early in their stay and help them get access to community providers who can provide ongoing care.
"Like every other hospital, we're seeing an increase in indigent patients. Many of these patients don't see a primary care physician and when they hit the hospital, they have major problems, such as cellulitis of the feet in patients with uncontrolled diabetes. Most of these patients have complex medical needs and will need additional care after discharge," she says Rosie Wilhelm, ACSW, LSW, director of social services for the 729-bed tertiary care hospital.
The hospital has dedicated social work staff that screen the patients for eligibility for categorical and entitle programs and pharmacy assistance programs. The hospital's goal is to make sure every self-patient is seen and screened for eligibility for programs that would help pay for their medical care and ongoing needs, Wilhelm says.
To help patients who may qualify for financial assistance programs, the hospital has a staff of 12 healthcare benefit assistance program social workers whose role is to educate patients and families about financial options and to help them apply for Medicaid, Social Security Disability, the Crime Victims Compensation Program and IowaCare. IowaCare is a Medicaid Demonstration Waiver Program that covers adults between the ages of 19 and 64, without insurances and with incomes of up to 200% of the poverty level. Patients who receive IowaCare benefits receive primary care at regional medical homes. When they are hospitalized, their care is provided at University of Iowa Hospitals and Clinics in Iowa City or Broadlawns Medical Center in Des Moines.
The healthcare benefit assistance program social workers receive training from the Iowa Department of Human Services to complete the applications for Medicaid and IowaCare. They get referrals from the hospital's business office and social workers. They visit the patient and family at the bedside, screen them for eligibility, and help them fill up the applications.
Many of the patients do not know that they may be eligible for the programs and feel overwhelmed by the process. "Enrolling can be confusing, so being able to provide this one-on-one assistance at the hospital bedside is invaluable," Wilhelm says.
With the healthcare benefit assistance program, social workers follow patients after discharge until their application is approved or denied. IowaCare benefits are usually approved within three to 30 days. It could take as long as two years for Social Security Disability benefits to be approved.
"This is a wonderful program for patients and the hospital. If patients are approved for retroactive Medicaid, the patient no longer has to worry about the charges, and the hospital has a revenue source," she says.
When unfunded patients need post-acute care, the hospital may pay the Medicaid rate for patients to receive care in a nursing home or rehabilitation facility while their Social Security disability is pending, under a 28E agreement with the Iowa Department of Human Services called the Revolving Fund. When the disability payments are approved and the patient qualified for Iowa Medicaid, the receiving facility bills Medicaid and pays back the hospital.
"We have been using Revolving Funds since the 1980s and it has been extremely successful. We compare the cost of keeping patients in acute care hospital and the cost of transferring them to a more appropriate level of care. There are advantages of moving the patient to the care setting they need, and to increasing the hospital's capacity to accept more acute patients," she says.
To help patients who cannot afford name brand medications, University of Iowa Hospitals and Clinics has five social workers who identify and enroll patients eligible for national pharmaceutical assistance for brand name medications. "This program has been very successful in helping people get the medication they need to avoid a readmission. If patients can't afford their medication to keep their medical status stable, they will be back in the emergency department or the hospital," Wilhelm says.
Source
- Rosie Wilhelm, ACSW, LSW, Director of Social Services, University of Iowa Hospitals and Clinics, Iowa City. Email: [email protected].
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