Financial <strong>Assistance</strong> Along the Cancer Treatment Continuum The Rex Healthcare Experience by Emmeline Madsen, MPH Figure 1. Percentage <strong>of</strong> Uninsured Individuals 4.4% – 9.9% 10.0% – 14.0% 14.1% – 16.0% 16.1% – 19.0% 19.1% – 23.7% Source: CRS analysis <strong>of</strong> data from 2010 American Community Survey, U.S. Census Bureau. 4 ACCC <strong>2013</strong> <strong>Patient</strong> <strong>Assistance</strong> <strong>and</strong> <strong>Reimbursement</strong> <strong>Guide</strong>
The number <strong>of</strong> uninsured Americans under age 65 has grown significantly during the economic downturn <strong>of</strong> recent years. Most economists attribute this increase to loss <strong>of</strong> employment <strong>and</strong>, consequently, employer-sponsored insurance. Those 65 <strong>and</strong> older remain covered by Medicare, <strong>and</strong> children under 19 years <strong>of</strong> age have maintained coverage because <strong>of</strong> incremental expansion in Medicaid <strong>and</strong> the Children’s Health Insurance Program. According to a November 11, 2011, report from the Congressional Research Service (CRS), the total U.S. civilian non-institutionalized population in 2010 was slightly more than 304 million. 1 Of those, 47.2 million (15.5 percent) were uninsured. 1 Percentages by state <strong>and</strong> an average national percentage <strong>of</strong> uninsured individuals are shown in Figure 1, opposite page. In the ranking <strong>of</strong> percentage <strong>of</strong> uninsured individuals by state, North Carolina ranks thirty-fifth. 2 In addition, about 17.9 percent <strong>of</strong> the U.S. GDP (gross domestic product) is spent on healthcare, a figure expected to increase to more than 20 percent by 2021. 3 With these daunting figures in mind, it becomes even more imperative for healthcare organizations, such as Rex Healthcare, to develop financially sound ways to support patients—even when they are unable to afford their care. Karen Hansen, MSW, oncology social worker, Rex Healthcare Kimberly Fradel, MSW, LCSW, oncology social worker, Rex Healthcare The Rex Healthcare Response Our goal is to provide financial assistance to patients for all <strong>of</strong> the care they receive <strong>and</strong> to ensure ease <strong>of</strong> patient access to care. Every day, Rex Healthcare provides more than $100,000 in charity care <strong>and</strong> write-<strong>of</strong>fs. We have an organized financial assistance program to help provide necessary care for our patients; however, these resources are limited to certain services <strong>and</strong> business entities <strong>of</strong> the Rex Healthcare system. For example, our financial assistance program, Rex Assist, is limited to hospital-based services <strong>and</strong> hospitalemployed physician practices. In addition, only medically necessary services are eligible for charity care consideration. Rex Healthcare screens all uninsured patients. <strong>Patient</strong>s without health insurance are automatically eligible for a 35 percent discount for qualifying services, regardless <strong>of</strong> income or eligibility for charity care. For patients whose income is below the U.S. Federal Poverty <strong>Guide</strong>lines, we <strong>of</strong>fer assistance via a contracted third party that helps with the Medicaid application process <strong>and</strong> follow-up. If the patient does not qualify for Medicaid, our staff completes a Rex Assist charity care application <strong>and</strong> forwards it to our <strong>Patient</strong> Financial Services. Criteria are in place to determine eligibility. Once approved, the patient is eligible for six months <strong>and</strong> the assistance is applicable toward all balances incurred prior to the approved Rex Assist application. As Rex Healthcare is now a member <strong>of</strong> UNC Healthcare, Rex Assist is reciprocal with UNC Hospitals’ charity care—saving patients <strong>and</strong> staff additional paperwork <strong>and</strong> frustration. <strong>Patient</strong>s with incomes equal to or less than 250 percent <strong>of</strong> the FPL <strong>Guide</strong>lines receive 100 percent coverage (see Table 1, page 6). Rex Healthcare physicians <strong>and</strong> practices also participate in Project Access, a physician pledge program through the Wake County Medical Society that provides care to uninsured individuals who qualify for the program based on medical necessity. For patients who qualify, this service, in conjunction with Rex Assist, <strong>of</strong>ten generates zero financial liability 5 ACCC <strong>2013</strong> <strong>Patient</strong> <strong>Assistance</strong> <strong>and</strong> <strong>Reimbursement</strong> <strong>Guide</strong>
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