Caring for uninsured patients: 4 key thoughts for ASC owners and operators

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Ambulatory surgery centers around the nation are devising ways to serve uninsured patients, but centers have to consider various factors when providing care for patients without health insurance.

ASCs must weigh the pros and cons. "Charity care is always a challenge; it is also about being a community servant," says Sandy Berreth, Medicare surveyor for Accreditation Association for Ambulatory Health Care and a former ASC administrator. "It can have enormous ramifications."

Providing care for the unemployed residents of the community gives a center some positive marketing. However, providing services isn't cheap. Ms. Berreth states many of the partners in a center may not agree the center should provide the care, especially if there is not a law requiring the center do so.
Some ASCs have the means; others do not. While many centers would like to provide care for those who cannot afford it, they may simply not have the financial means. Additionally, the centers may have to gain approval from a board that may determine the cost is too much for a center to bear. ASC owners and operators championing charitable care initiatives can present the issue to board members in a way that persuades them to approve charitable efforts.

"For many smaller rural communities, it is about helping your community and if presented properly to the board some procedures will be acceptable," says Ms. Berreth. "It might be about volume. If some cases have greater reimbursement and some don't, it often creates an acceptable balance."
ASCs have many factors to consider when serving individuals without health insurance. Often, their ability to provide services depends on the type of procedure, which dictates the cost.
Providers often pay for the procedures. When serving uninsured patients, the provider has to eat the cost. Healthcare providers cannot collect payment from someone who is struggling to pay for basic necessities. "Health insurance is not on their radar. They are just playing the odds, when the odds are stacked against the unemployed," says Ms. Berreth. "It becomes healthcare providers' issues."
The patient population determines if an ASC or hospital will receive reimbursement for procedures, and they simply will not get paid if the money is not there and like any business, surgery centers need capital to survive and continue to serve residents.
Both hospitals and ASCs need money for its daily operations, and the way centers are being paid is changing.

"In the past, hospitals would be compensated from Medicare based on their reporting to 'make-up' the difference," says Ms. Berreth. "Hospitals have cost centers just like the ASC and although they are not-for-profit, they must make a profit."
Hospitals may have more capital to provide care for the unemployed, but they need to have the procedures approved by a board of directors. Approval is necessary, and board members carefully consider the financial standing of any facility.
The ACA reduced uninsured population. The CDC reported more than 90 percent of Americans have health insurance with nearly 16 million more Americans being insured in 2015 and 2013.
In 2015, ASCs reported that Medicare reimbursement was only 15 percent to 35 percent of the gross charges. With reimbursements being so low, facilities often have to pay for the care themselves since patients cannot. "Many ASCs will comment that Medicaid is charity care, so, of course, if the ASC is Medicare-certified, they will take some Medicare/Medicare patients," says Ms. Berreth.

While many Americans applauded the Obama administration after the stark increase in the number of insured Americans, the questions remains as to how much the ACA really helped the American people. The unemployed rate is 5.1 percent, which may seem quite small. However, this number comprises 8 million individuals, many of whom will need care at some point in their lives and will not likely be able to afford it.

"The Affordable Health care act was supposed to help, I think the jury is still out; it is a political debate," says Ms. Berreth. "How do we, who are more fortunate, take of care those who are not?"

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