Pointing to a study he delivered at a recent (Congressional Health Care Caucus), Phil Lebherz, Founder and Executive Director of the Foundation for Health Coverage Education (FHCE), has called upon Congress and the Obama administration to make 2012 a watershed year for adopting a “Point-of-Care” approach with Medicaid’s administrative program in an effort to save as much as $56 billion in administrative costs.

The costs being targeted are derived from complicated and duplicative steps that keep government administrative costs high and prevent qualified Medicaid recipients from seeking needed care.  Delayed treatment often results in higher overall costs, as patients are treated in hospital emergency rooms with higher incidence of requiring surgery and expensive intensive care services.

“If we continue to run government’s biggest program – Medicaid utilizing the program with 1980s technology, we will be out of money before we reach 2014,” said Lebherz.

In his testimony before the Congressional forum, Lebherz laid out the reasoning behind changing Medicaid from a complicated enrollment system to a “point-of-care” program by describing the current holes. The proposed (Point-of-Care Eligibility) system would target a large segment of the population who are eligible for Medicaid, yet are not enrolled, and access their care in hospitals’ Emergency Rooms. With these patients, the hospital is often left with unpaid bills that should be turned into Medicaid or another liable public entity.

The solution of moving to a Point-of-Care concept was created following (Onsite Study) conducted at four Emergency Rooms in San Diego, California in 2011. Over a period of a year, Sharp Healthcare asked 20,000 uninsured patients FHCE’s Eligibility Quiz, and 80.2% were found eligible for free or low-cost public health coverage.

A previous analysis of Medicaid numbers, detailed in this 2011 (Health Affairs article), demonstrates that a “point-of-care” system could solve the uninsured problem for an estimated 17 million Americans and trim billions of dollars from the government budget.

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