Editor's note: H&HN Staff Writer Marty Stempniak is blogging this week from the Hospital Financial Management Association's National Institute 2012.


LAS VEGAS — All kinds of studies have been done in the past to find links between a patient's race or ethnicity and his or her final outcome at the hospital. But what about credit history? If Joe Patient's house is in foreclosure, will it affect his ability to obtain a prescription or follow through on an appointment?

That's the question Florida-based Shands HealthCare is in the very early stages of tackling, with the help of one major U.S. credit bureau. Many hospitals already use such data for bill collections or other nonclinical efforts. But few, if any, have used it as a way to try study and improve population health, according to those involved.

"What Shands of Florida had the idea of saying is, 'Would it be helpful for us to know some of these socioeconomic issues affecting the community, as well as patient demographics, as well as geography and as well as disease rates? That was really the premise behind this study," Scott Hawig, former vice president of finance for Shands, told attendees during a Tuesday afternoon session at HFMA's National Institute 2012, in Las Vegas.

Shands is a large, nonprofit health system, whose reach stretches across 67 Florida counties, two academic medical centers, 1,668 licensed beds, and physician practices at more than 80 outpatient clinics. With such a wide reach, serving myriad races and economic classes, Shands was curious whether it was deploying all its resources properly to reach all corners of the community. Credit bureau TransUnion helped the medical center to study some 350,000 patient visits in 2010, and the two sides revealed the preliminary findings on Tuesday.

Hawig quizzed the audience, asking whether they thought patients who visit the emergency department or family medicine practices had higher average credit scores, and the majority pointed to the ED, assuming that low-income patients with no insurance were making those trips. But the opposite was true, Hawig says, and it's unclear why in the early stages of their analysis. Some 50 percent of Medicaid patients had no credit score, according to the study, and nearly 40 percent of Medicare patients had no credit score. If a high percentage of joint-replacement patients are behind on their mortgage, he asked, does that mean they're going struggle sticking to their involved discharge plan?

"Almost a quarter of those folks are either behind or have defaulted on their mortgage," Hawig says. "Is that a sign of compliance for a procedure that requires a high degree of compliance to have a good outcome?"

So what's next? Shands hopes to match up the socioeconomic info with the rest of its patient data. They'd like to eventually use it to improve case management, and as ammunition when applying for grants to target their service area's underserved populations. The effort may end up being a bust, Hawig says. But he expects more hospitals to start gathering such data, with demands from the feds to manage population health and figure out why two patients, given the exact same treatment in different hospitals, have different outcomes.

"Is this valuable? Is it a needed piece of information? We may find out it isn't," he told me after the session. "Right now it's so new that we're still dabbling with it, and so we need to see if we can find some successful cases where this did help us put the right service in the right location. It's still very early."