Hosps Can Provide Discounts to Uninsured and Needy Patients

[DeepModem Mom]

New York Times:


Hospitals Can Provide Discounts to Uninsured and Needy Patients, Bush Administration Says
By ROBERT PEAR

Published: February 20, 2004

WASHINGTON, Feb. 19 — The Bush administration encouraged hospitals on Thursday to give discounts to uninsured patients and to financially needy Medicare beneficiaries.

Such discounts are permissible under federal fraud and abuse laws, the government said, in a clarification requested by the hospital industry.

Hospitals have been criticized in the last two years for charging uninsured people much more than they charge people with employer-sponsored health insurance. Group health plans often negotiate rates lower than the prices charged to people without insurance....


***

More than 43 million Americans, including nearly one-third of Hispanics, are uninsured....

***

Melinda R. Hatton, vice president of the American Hospital Association, said the guidelines did not go far enough. "It's still not entirely clear what hospitals can do to help the working poor," Ms. Hatton said. "How much of a discount can they give to a family of four with income of more than $37,000 a year?"

The new guidelines are a bit stricter for Medicare beneficiaries than for uninsured patients.


more:

http://www.nytimes.com/2004/02/20/politics/20INSU.html

[mouse7]

1. Oh Boy. 10% off your next liver transplant! Whoopie!

$500,000 cost of liver transplant - 10% for Perky Patient Discount Card = $450,000 bill.

Gee, thaaaaaaanks.

[MichaelHarris]

2. Spouse of a physician

Yeah, thats gonna work. Anywhere in that plan to reimburse the hospitals closing all over America because the bush era insurance companies not paying charges? This is like telling Walmart to lower prices to stimulate spending and so poor people can shop. Who in the hell advises bush? Bo Bo the chimp faced kid?

[ret5hd]

3. Isn't it more like...

the hospitals "asking permission" to not rape and gouge the uninsured?

Has anyone or any company ever before asked the gov't if it is OK to lower prices? Sounds more like the hospitals are purposely obfuscating the issue to hide their complicity in gouging the uninsured.

"No sir, I am sorry. We cannot charge you the same price we charge an insured person because the federal government won't let us."

Yeah, right.

[MichaelHarris]

4. I'm not sure they do

I think the way the proposal is written its, making the hospitals and medical profession the villain here. I know my wife and her entire practice charges less or nothing at all to the underprivileged here.

[ret5hd]

5. this is what i'm talking about.

<snip from orig. posting>
Hospitals have been criticized in the last two years for charging uninsured people much more than they charge people with employer-sponsored health insurance. Group health plans often negotiate rates lower than the prices charged to people without insurance....
</snip>

Your wife and you should try going to an emergency room with the exact same symptoms--one claiming to have insurance and the other claiming to have none.

See who walks out with the (much) larger total bill.

[MichaelHarris]

6. I understand the criticizing but there is more to this.

"Group health plans often negotiate rates" they never negotiate this, thats all they pay. No negotiation involved. I can't speak for the all hospitals per se but my wife is on the board of both hospitals here as well as the board of her own clinic and they have "reduced" rates for the uninsured and unemployed. In fact every time she sees a Medicare or Medicaid patient it costs her 15 dollars after her overhead. Even with that loss she has chosen to treat anyone who needs her. She even makes house calls LOL. I'll be mowing the yard and people come up with like wounds and stuff. I look at um and say, "man, you better put a bandaid on that" :)

[FlaGranny]

8. I found out a long time ago that

insurance companies pay about 80 percent (for standard insurance) of the actual hospital and physician charges. The patient gets a bill for, say, $1000. The insurance pays $800. The rest is a write-off. In an identical case, the uninsured patient gets the bill for $1000 and is expected to pay it - all of it. I also found out, from experience, that most hospitals and physicians WILL negotiate that 20% off your bill, but the patient has to ask for it. We used to have mostly nonprofit hospitals in this country and there is a law that nonprofits must treat indigent patients without charge. There are very few nonprofits any more and I really don't know what the law is regarding a for-profit hospital treating indigents - if there is one.

While I am sure there are many physicians like your wife, I don't know many. I do know one oncologist who will treat indigent cancer patients, even to the point of taking the hit for cancer drugs, if he has to.

[davsand]

9. Most hospitals ARE still non-profits.

Many if not most still carry a non-profit (501 (C) 3) IRS designation. The big difference is they are run like corporations now rather than the places of caring they USED to be. If you are under insured or uninsured and you need a hospital, you will pay for this for the rest of your life or can possibly end up in jail if they don't like the amount you can pay on your bill or if you miss a payment.

http://bernie.house.gov/documents/articles/20031031155424.asp

The above link is to a copy of a Wall Street Journal article that published at the end of October. One of the hospitals talked about in that article (Provena) was literally just stripped of its Illinois Tax exemptions due, in part to its lack of available and advertised charity care and aggressive collection practices.

I was on the local board that recommended to the Illinois Dept of Revenue that that exemption be stripped. Essentially, what we've done is, we used the leverage of LOCAL government and we are forcing them to work on the issue of indigent care.

Illinois State Property Tax law is quite specific in both the rulings and in actual statute about the fact that hospitals must provide charity care and they must make it available for all who qualify IF that hospital wants to remain tax exempt in Illinois. I suspect that this is not peculiar to just Illinois.

This single ruling is causing HUGE shock waves in the American Hospital Association, and across the nation. Currently, the Hill-Burton act (which was a federal law requiring hospitals who got certain federal funding at one point in time) has been mostly fulfilled, and as a result there ARE no federal requirements that hospitals provide any charity care at all. The only protection for poor people are local ones--and most locations are not aware of this. Certainly, most patients are not aware of it.

IF this health care situation is going to change at all for the better, it will have to come from local action. The Feds were actually exploring the idea of backing off on the laws requiring that ERs must provide care to any critically ill person who turns up--let alone poor people in need of treatment for ongoing problems.

Laura

[FlaGranny]

14. Interesting.

Most, maybe all, the hospitals in my area are owned by large chains. Do you mean that they could still legally be tax-exempt and do business as non-profits? I'm not up to date on this as much as I used to be, but, if that's the case, the situation is even worse than I thought.

[davsand]

15. Approximately 85% of hospitals are tax exempt.

Recent stuff I saw out of the American Hospital Associations says 85% of hospitals are viewed as "non profits" by the IRS. So yeah--they can be owned by any of the major hospital corporations and still hold that 501 (C)3 exemption from the IRS.

The entire IRS designation of a non-profit is a real misnomer anyhow. I'll give you a case in point--one of our local "non-profit" hospitals is wailing like a banshee that they are being looked at for the amount of charity care they give the community every year. They are looking at something like a 50 or 60 million dollar expansion project--they plan to put the profits back into the hospital so it is "OK."

That IRS designation is very vague about what qualifies and what doesn't. The hospitals are on this because it is presumed they are an asset to the community in which they reside. They provide ER services and neonatal services and all the other stuff. In some cases they also have people arrested if they don't pay or if they don't pay enough.

Because they are seen by the IRS as a non-profit--they don't pay taxes, including, in many cases, property taxes. IF you rent or if you own property in that area YOU are subsidizing those hospitals. YOU are paying for them to be in your community. Are you getting your money's worth from them? ARE they giving back to the community in charity care what they take out?

Here are two articles from our local paper today about this entire issue:

http://www.news-gazette.com/story.cfm?Number=15483

The one above tells some great info about our local situation, but the one below does a good job of explaining charity care and how it needs to work:

http://www.news-gazette.com/story.cfm?Number=15484

These two articles appeared together in our paper today!

This stuff can have major impact across the nation--IF we wake up and take it on. It has got to come from us. It surely isn't gonna come from the Federal Government...

Laura

[MichaelHarris]

10. I got a little more info

I just asked my wife to make sure I was right and she told me that its against the law for hospitals and physicians to charge more for the uninsured. They have to bill the same for the insured and uninsured. There is a list of what a procedure should cost and they have to stick to that. For some things like elective cosmetic stuff I'm not sure about. I mean a nose job in LA may cost 15,000 and the same nose job in Wink, Texas may cost 29.95.

[davsand]

11. They are holding hearings here in Illinois about that now.

The practice does go an and there is not a federal law to prevent it. Any regs that your wife deals with are most likely from your state.

Lucky you to live in a state that is progressive enough to have that kind of law in place!

Laura

[MichaelHarris]

12. Washington is pretty strict

Washington St is pretty strict with doctors. She's licensed in Wa, ID, and TX. I don't know about Tx because she just keeps her fees paid because of family. I know Idaho is pretty strict and has a large population of uninsured.

[KayLaw]

13. Forgive my ignorance

I really was unaware of that issue - the insurance companies not paying up. I know how ridiculous my own insurace company is about rules, procedures, etc. My own doctor has an employee who does nothing but deal with the insurance companies all day long. My doctor wanted to give me a wrist break but we had to clear it with the employee I mentioned. Nope. I had to drive to another town to pick up a brace. They used to but now won't let her draw blood - I have to go to a special drawing station and wait with a million other people. Same with the meds she wants to prescribe. They make her job so difficult, and I don't have some rinky dink company either. I have Aetna.

[salin]

7. strikes me the use of the word "can"

I have to read the whole article... but whenever they use "can"... I think... "voluntary"... e.g., the govt requires nothing of the entities and do not expect any org to comply/volunteer.

Did you know, that in the medicare/prescription drug legislation - there was an item to give corporations a tax break... IF they did not discontinue health coverage to retirees... BUT then in the final negotiation moved it to a "can" type statement where the companies get the tax break regardless of whether or not they continue retiree health coverage. So if the corp get a tax break regardless - but can cut costs by booting longtime employees now retirees from health coverage... why would they continue the coverage?

[DeepModem Mom]

16. kick -- posted early this a.m.

[leesa]

17. What the hell does he think they have been having to do for years now??

They write off as much as they can while the greedy insurance and drug companies laugh all the way to the bank. Every day at the hospital I work off we are begging to write costs off...and they do it even though they can barely make ends meet.

[teryang]

18. What a pathetic political ploy

The regime is being heavily damaged by the democratic health care policy message and this pathetic repuke response is the answer.

It's not likely that medicare recipients are going to be given discounts for hospital stays, nor is it likely that Hospitals will give up their lien rights for unpaid bills.

A bigger problem is just the opposite providers, hospitals and other health care entities overbilling, and outright fraud for medicaid and medicare services.