Evolving consumer-driven healthcare creates financial risk for hospitals

CHICAGO (August 24, 2015) – Hospital financial risk is shifting as the uninsured self-pay population decreases and the newly insured population increases. This is due to the rising number of high-deductible health plans (HDHP) and the reduction in the uninsured self-pay population, 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 generates finance and revenue-cycle benchmarking results for several key performance indicators. The quarterly Crowe RCA Benchmarking Analysis examined patient account transactional data from 444 hospitals through June 30, 2015.

“The replacement of traditional health plans with HDHPs is creating more patients who are not only newly insured, but who bear significant financial responsibility via copays and high deductibles,” said Cory Herendeen, a principal in Crowe Performance Consulting. “This has created more financial risk from the insured self-pay population.”

Notably, total accounts receivable (A/R) from insured self-pay patients increased 13 percent in the past year. Total A/R over the same time period from uninsured self-pay patients decreased 22 percent, mostly as a result of high financial risk patients joining Medicaid in expansion states.

This edition of the Crowe RCA Benchmarking Analysis expounds on findings from earlier this year, which showed that the growing HDHP population contributes to a larger share of uncompensated care. This concurs with previous data indicating that an astounding 84 percent of hospitals have yet to create specific HDHP codes in their patient accounting systems.  

The analysis also reveals market trends in payer mix, volume and net revenue per case, accentuating key differences between Medicaid expansion states and non-expansion states. 

About the Crowe RCA Benchmarking Analysis 
The Crowe RCA Benchmarking Analysis includes 444 distinct hospitals classified as acute, critical-access, rehabilitation, psychiatric or cardiovascular care facilities. The database contains information from hospitals in 37 states, with 20 or more facilities represented in Colorado, Florida, Kansas, 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.