Evolving Patient Population Causing Shifts in Uncompensated Care

Quarterly edition of Crowe data analysis shows higher financial risk from increasing patient responsibilities.



CHICAGO (June 17, 2015) – Healthcare providers should be mindful of the ever-growing high-deductible health plan (HDHP) population, a result of the newly insured and the migration of employer-sponsored health plans, according to Crowe Horwath LLP, one of the largest public accounting, consulting and technology firms in the U.S.

Crowe Revenue Cycle Analytics (Crowe RCA) software uses patient account transactional data to generate a variety of finance and revenue-cycle benchmarking results for several key performance indicators. The Crowe RCA Benchmarking Analysis, which analyzes data from 420 hospitals through March 31, 2015, reveals important metrics related to the insured patient population, the increase in self-pay after insurance uncompensated care and how providers can address the associated financial risk.

“The expansion of Medicaid coverage and the insurance exchange marketplace has significantly reduced the uninsured population, which has always been the biggest contributor to uncompensated care dollars,” said Cory Herendeen, a principal in Crowe Performance Consulting. “While the uninsured still comprise the majority of provider uncompensated care, we are seeing consistent growth in the share of uncompensated care associated with the insured patient population.”

The analysis shows the continuing increase in HDHP adoptions and the impact on the healthcare industry. The number of HDHP enrollees increased from 15.5 million to 17.4 million from 2013 to 2014, a trend that will require providers to more proactively identify this evolving patient population at the outset of the patient access process and take into account their responsibility to pay for healthcare.

Herendeen added, “Due to the rollout of the Affordable Care Act, we expect the surge of HDHPs to continue as patients seek health plans with lower fixed premium costs. Currently, an astounding 84 percent of hospitals are not creating unique HDHP codes while an additional 9 percent are not effectively registering this growing insured patient population, which makes them prone to revenue leakage and financial risk.”

In addition, insured patients’ share of total uncompensated care increased sharply from 2013 to 2014, with bad debt and charity rates up 22 percent and 130 percent, respectively, in Medicaid expansion states. In nonexpansion states, bad debt and charity rates were up 35 percent and 130 percent, respectively.

More recently, when comparing the first quarters of 2014 and 2015, the latest benchmarking results revealed consistent change among key performance indicators (payer mix, volume and net revenue per case), signaling continuing shifts in payer demographics and noticeable differences between Medicaid expansion states and nonexpansion states.

About the Crowe RCA Benchmarking Analysis
The Crowe RCA Benchmarking Analysis includes 420 distinct hospitals classified as acute-care, critical-access, rehabilitation, psychiatric or cardiovascular care facilities. The database contains information from hospitals in 35 states, with 20 or more facilities represented in Colorado, Florida, Indiana, Kentucky, Ohio, South Dakota, Texas, and Wisconsin.

For more information about the Crowe RCA Benchmarking Analysis, please visit www.crowehorwath.com/benchmarking-release.

About Crowe Horwath
Crowe Horwath LLP (www.crowehorwath.com) is one of the largest public accounting, consulting, and technology firms in the United States. Under its core purpose of “Building Value with Values®,” Crowe uses its deep industry expertise to provide audit services to public and private entities while also helping clients reach their goals with tax, advisory, risk and performance services. With offices coast to coast and 3,000 personnel, Crowe is recognized by many organizations as one of the country's best places to work. Crowe serves clients worldwide as an independent member of Crowe Horwath International, one of the largest global accounting networks in the world. The network consists of more than 200 independent accounting and advisory services firms in more than 120 countries around the world.


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Amanda Reich
Amanda Reich