Medicaid Work Rules Could Strain Hospitals: Laxmi Patel

Proposed Medicaid reforms under HR 1 could place significant new strain on hospitals and providers, according to Laxmi Patel, chief strategy officer at Savista. In this interview, she notes that work requirements and more frequent eligibility redeterminations may reduce the covered patient base, increase uncompensated care, and add costly administrative and technology demands.

Smaller practices and community hospitals may struggle to absorb these expenses, potentially limiting their ability to serve Medicaid populations. Patel notes that technologies such as artificial intelligence (AI) may help streamline documentation and eligibility verification by pulling data and integrating them into the electronic medical record (EMR) and electronic health record (EHR) workflow. However, she also cautions that interoperability gaps mean automation can only go so far.

Check out part 1 of this interview, where Patel outlines how these reforms would affect patient eligibility and coverage.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What do you see as the most significant operational and financial impacts for hospitals if the proposed Medicaid work requirements and eligibility redeterminations are implemented?

As it comes to kind of that Medicaid work requirement and reporting requirement, even on the ACA [Affordable Care Act] expansion group, there will be a significant drop in the covered patient base, especially in rural, low-income clinics and community hospitals. Billing processes are going to become more complex, probably leading to delays in payment or a rise in uncompensated care. Providers will face a greater administrative burden as they attempt to navigate some of these new requirements; they are going to divert time and resources to create these processes and structure.

To manage the increased frequency of eligibility redetermination, providers may need to overhaul some of their operational workflows, may need to invest in technology or hire additional staff, maybe update their IT system to manage the documentation storage, the verification process, and then trigger retraining, or even have to find partners that can kind of take on this burden for them. For smaller practices and community health centers, these investments are probably prohibited from an expense perspective, so it's going to limit their ability to, over time, maybe serve that Medicaid population, and their only option may be to kind of outsource this fundamental process that many community hospitals maintain internally, because they can't take on that technology operational process for themselves.

Can AI or other technologies help hospitals manage these changes?

AI can mean many different things. I think one of the places that [is] a little more on the proactive side is, using technology, whether it's AI or a different form, but maybe automate the eligibility and documentation, capture at the front end of a touchpoint. If you are scheduling appointments—during registration or scheduling or as part of the clearance process—have a partner or have the technology be able to pull income, pull residency, pull employment data from a trusted third-party source, and integrate that within your EMR/EHR workflow.

That gets that information that may not be available to patients, and they also could reduce no-shows and care delays. I think thinking about AI broadly to help support, it's really about process movement vs it creating a more of a holistic automated system, because I don't think we have the interoperability to create that functionality and prevent some of the manual work that's going to come out of this.