Compliance in New Financial Assistance Laws

Cheryl Cathlin(0:09) Alright, I'm here today with Laura Robbins from Advocatia, and Laura is the Chief Compliance Officer, Chief Operating Officer for Advocatia. (0:22) Tell us a little bit about your role and what your company does.

Laura Robbins(0:26) Yes, so at Advocatia we have a platform and it allows for both the patient as well as financial counselors, social workers, and other access points within the hospital to screen and enroll patients into available programs. (0:40) So largely that's focused on government programs like Medicaid and other cost savings programs, but we also do a lot of hospital-specific charity care and unique county programs as well.

Cheryl Cathlin(0:52) Okay, awesome. (0:53) And today I wanted to talk to you about the focus we're seeing from the states and healthcare providers on financial assistance programs, charity care programs. (1:05) Seeing a really huge legislative push recently. (1:09) What are you seeing as kind of the motivators for the push for more legislation, more policies from providers on financial assistance?

Laura Robbins(1:21) Yes, so from a legislation level, I believe it's really rooted in how cost, that cost of healthcare. (1:29) So the medical debt is continuing to increase and being a burden on consumers across the country. (1:36) And what that means is less access to care, people not getting treatments because of that cost. (1:42) And so having those programs in place to allow for a hospital, especially a non-for-profit, to communicate those charity care programs has become a trend in legislation. (1:53) I'd say since around 2020, we started to see that pass in several states at a state and federal level.

Cheryl Cathlin(2:00) And what are the requirements or the kind of common themes that you're seeing in some of the state laws regarding financial assistance?

Laura Robbins(2:11) So the states do vary greatly in the programs and how they are launched. (2:16) In Illinois, for example, it launched this year, July 1st, so it hasn't launched yet. (2:21) We're at the most convenient access point as soon as possible (2:26) Hospitals are supposed to screen for not only Medicaid and charity care, but also other programs that are available to patients so that the patient knows that those programs are available and that they can access them if they're under-resourced. (2:39) And so we've been seeing hospitals in Illinois trying to stand up technology to easily scale that, especially with workforce shortages. (2:48) It's another item that they want to be compliant and communicate to their team members how to communicate all of these programs, which are dynamic programs for screening.(2:59) And we also want to make sure that patients are aware at the earliest convenient point possible.

Cheryl Cathlin(3:06) Yes. (3:06) You mentioned the Illinois law. (3:08) I know Oregon also just had a law that went into effect recently. (3:13) We have a couple of clients working on implementation for that. (3:16) That is going to require presumptive screening, and so automatic screening for patients that fall within certain categories, whether it's FPL, they're billed over a certain amount, underinsured or uninsured. (3:32) What is your experience with the presumptive eligibility piece?

Laura Robbins(3:37) So we have seen an increase in presumptive eligibility just across the country. (3:41) We're live in 36 states now with clients, and we see those programs, they are different. (3:48) But for presumptive, especially larger clients that we have with several facilities across states, they don't have the manpower to be screening and communicating the charity care program. (3:58) So we do see that scaled out. (3:59) But we also see some benefit to making sure that you do screen every individual that you can because they could be eligible for Medicaid. (4:07) And so you'd rather have them enroll into Medicaid so that they'd have access to care moving forward, even if it's a low dollar. (4:14) So we see a lot of presumptive really being pushed out, which is completely understandable, especially at a scaling aspect. (4:21) But then that limits potentially some access to care as well if the individual does qualify for Medicaid and other programs.

Cheryl Cathlin(4:29) What kind of challenges are providers faced with? (4:32) I mean, you mentioned the presumptive screening just across the board. (4:36) So I can imagine this is coming with a lot of challenges for providers (4:42) What are you seeing are the biggest challenges for providers in keeping up with the new laws?

Laura Robbins(4:49) You know, I'd say it's multifactor. (4:51) So there's, first of all, staffing shortages. (4:54) So hospitals, it's coming during a time where you have legislation being enforced and with shorter deadlines than I think gave hospitals a time to really ramp up and execute on the those requirements. 

(5:08) And so then you're also seeing at a time where there's shrinking margins and their capacity for their team members is also low and, again, those workforce challenges that they're experiencing. (5:20) And so really finding somebody that can help scale a screening availability and be flexible with the changing requirements. (5:28) Because not only do providers change their charity care programs, sometimes annually, but also Medicaid rules change and other programs can change, you know, sometimes annually, sometimes more frequently. (5:40) So having something that can scale and change and be flexible with those program changes is really important. (5:47) Otherwise, the processes will be very much heavy and relying on manual training. (5:53) So you need to have something that's selected that's scalable.

Cheryl Cathlin(5:55) What solutions are providers turning to to help them keep up with the changing laws?

Laura Robbins(6:04) You know, I think they really look to experts in the industry, especially within revenue cycle that are familiar with the different laws and charity care, especially with compliance. (6:15) And so, you know, we see a lot of our clients reaching out to us to see how can we help with those changing rules or if they have a trusted revenue cycle management partner, you know, working with them to see, you know, how can we make sure that we have enough staff and that we can make sure that we're compliant and also have reporting. (6:33) So a lot of those laws do have reporting requirements. (6:36) For example, in Illinois, they have to report the five top reasons why a patient is not enrolling into the financial assistance program. (6:44) And so they have to make sure that data does not take too long to pull and too many resources away from their team as well.

Cheryl Cathlin(6:50) Oh, wow. (6:50) Interesting. (6:51) What other challenges do you see the providers facing? (6:56) Maybe on the patient engagement side, like how do the providers make this a quality experience for patients?

Laura Robbins(7:05) Yeah, that's a great question, because you see, you know, hospitals and providers, they want to make sure that if a patient is under resourced, that they know that they qualify for these programs. (7:15) So historically, we've seen providers across the country included in statements. (7:20) So through the mail, they're sending it. (7:22) If a patient requests it, they'll send a mail, even with a return stamp, an envelope, ready to go, making it as convenient as possible, as well as on their website. (7:33) We do see most hospitals have it listed on their website and around their facilities. (7:37) But not all patients want to engage that way. 

(7:40) And so having a multi-channel approach is really important. (7:44) We saw industry standards across the board was single digits of response rates. (7:49) Even when a patient was asking for a charity care application (7:53) And so by texting them that application to allow them to self-service, attach documents that are required, apply their signature. (8:01) We did see an increase to as high as 87 percent response rates when they're working with our team. (8:09) Across advocacious clients, we see 40 percent response rates to capturing signatures and documents (8:17) Because that's really a challenge is having the patient send in those documents. (8:22) If you think about it, you're asking for bank statements, you're asking for W-2s, you're asking for really personal information. (8:30) And so having them come back into the hospital and have that availability. (8:35) But also, if it's two o'clock in the morning and that's the time they have to snap a picture and send it, we want to make sure it's as, again, as convenient as possible. (8:44) And we've seen that patients really appreciate that. (8:48) In our platform, we have patients' reviews out of five stars, and we've seen a 4.7 star out of five. (8:56) Reviews. (8:57) Oh, wow. (8:57) Just that it's easy for them to navigate.

Cheryl Cathlin(9:00) Right. (9:00) Making it more accessible, visible. (9:04) I know a lot of the state laws are encouraging, well, making it mandatory for the providers to make their policies, their financial aid policies more visible (9:14) But you make such a great point about it can't just be about visibility. (9:18) It has to be about accessibility. (9:21) And so the multi-channel approach, I think that's so important. (9:25) So how do we engage providers and educate them about these new laws? (9:32) How do we get them involved in the legislative process so that they have a voice, they have a seat at the table?

Laura Robbins(9:39) That's a great question. (9:40) I feel like a lot of the focus has been on non-for-profit hospitals, and you hear more on the headlines when those slap-on-the-wrists are occurring and when there's those penalties. (9:50) And I think a more collaborative approach is, again, bringing providers to the table, understanding what challenges they have and why some of these things haven't been executed to date would be very important. (10:01) And I know there's different organizations that will bring them to the table, but sometimes it's after it's already been passed, and that's not the point where we should be bringing providers. (10:12) And who's going to ultimately be executing this communication to the patients?

Cheryl Cathlin(10:16) Yeah. (10:17) Now, I want to ask you about maybe some unintended consequences of these laws and this new focus on expanding financial assistance programs or just some unintended consequences that you're seeing.

Laura Robbins(10:34) Yeah. (10:35) You know, I think legislation always had good goals with bringing that in. (10:39) They want to make sure that patients know what's available to them so that they don't have medical debt continue to build. (10:45) But those unintentional consequences come when you're pushing something onto a facility that doesn't have time to prepare for that. (10:55) There's lots of priorities in place and different integrations occurring, different decisions. (11:00) And so by not giving providers enough time to plan and execute that, it does put them in a position where they have to choose to either rush that process or at times not be compliant and they have to weigh that risk because they know that they can't stand something up quick enough with low capacity at this time.(11:21) Right. (11:21) And that's where we've been fortunate to be able to be engaged and other people and organizations and revenue cycles to step in and provide a solution that can quickly be implemented to meet those needs.

Cheryl Cathlin(11:35) And have you seen standardization across hospitals, providers as far as workflow processes related to the financial assistance programs? (11:48) What are you seeing as industry best practice?

Laura Robbins(11:51) Yeah. (11:51) So I think with industry best practice, it's always an integrated way. (11:55) So if you choose somebody that can integrate with your EHR where everyone has access to that as well as something that's just very easy for the whole team to access. (12:06) So in Illinois, for example, when you are insured, if you call the patient access team, they need to be able to have the ability to screen you. (12:14) And again, those are dynamic programs that aren't always easy and there's multiple programs. (12:20) So really just giving even the team at the hospitals the ability to help when a patient calls, easy to access, and then have that flow back into the EHR and really just clear reporting metrics so that you can click a button and get the report that you need versus having to spend days with pivot tables and excels so that you're utilizing your team resources appropriately.

Cheryl Cathlin(12:46) That's really good advice for providers. (12:48) Any last tips or takeaways that you would leave for providers as they consider and navigate the different legislative changes that we're seeing related to financial assistance and charity care?

Laura Robbins(13:05) You know, I really believe in the patient experience. (13:08) So at Advocatia, making sure that you have multiple tools available for your team and multi-channel approach for your patients. (13:16) So again, selecting a partner that can help with the technology, but that doesn't mean that you're going to lose snail mail either or bedside assistance. (13:26) I think that different patients have a different preference in communication and sometimes we know that too. (13:32) So making sure that you choose a trusted partner that you know can execute and help you scale, especially if you're a provider in multiple states, that understands the compliance and what is required in each state is really important. (13:46) Awesome.(13:47) Well, thank you, laura.

Cheryl Cathlin(13:48) It was so nice to meet you. (13:49) It's so great to meet you and thanks for having me on.