Sunday, 22 February 2004
-
Here is some good news!
Federal Rules Do Not Bar Hospitals From Giving Discounts to
the Uninsured, Bush Administration Says
Access this story and related links online:
http://cme.kff.org/Key=1962.TM.C.D.NjrYnj
In a "toughly worded response" to hospitals, HHS Secretary
Tommy Thompson on Thursday said that federal regulations do not
prevent hospitals from offering discounts to uninsured patients,
the Wall Street Journal reports (Lagnado, Wall Street Journal,
2/20). In a letter sent to Thompson in December, the American
Hospital Association asked HHS to change or clarify pricing
schedule rules so that hospitals can give discounts to uninsured
patients without worrying about violating Medicare rules.
According to hospitals, Medicare regulations require them to
keep a uniform price list for treatments and procedures for all
patients (Kaiser Daily Health Policy Report, 12/17/03).
Hospitals often bill the uninsured for "full charges," or the
list prices that hospitals maintain for every item and
procedure. Insurance companies and the Medicare and Medicaid
programs often pay lower rates, the Journal reports. According
to hospitals, Medicare policy requires "aggressive efforts to
collect from all patients," including those who are uninsured.
Hospitals also believed that Medicare policy did not allow
hospitals to provide discounts to the uninsured. Medical bills
are the second leading cause of personal bankruptcy, and
hospitals have "come under fire" for what they charge and what
tactics they use to collect unpaid bills, the Journal reports
(Wall Street Journal, 2/20).
Thompson's Response and Guidelines
In a letter to AHA President Richard Davidson, Thompson said,
"Nothing in the Medicare program rules or regulations prohibit
such discounts" to the uninsured. Thompson also said that
hospitals should "take action to assist the uninsured and
underinsured, and therefore end the situation where, as you said
in your own words, uninsured Americans and others of limited
means are often billed and required to pay higher charges"
(Denver Post, 2/20). The letter includes an accompanying
document with a "road map for hospitals in the form of a
question-and-answer dialogue," the Journal reports. One of the
questions asks: "Are hospitals required to take low-income
patients to court or seize their homes or send claims out to a
collection agency when those patients don't pay their hospital
bills?" The answer: "No. Nothing in the Medicare instructions
requires the hospital to seize a patient's home, take them to
court, or use a collection agency." It adds that hospitals are
not required "to engage in any specific level of collection
effort for Medicare or non-Medicare patients" (Wall Street
Journal, 2/20). "Hospitals can provide discounts to uninsured
and underinsured patients who cannot afford their hospital bills
and to Medicare beneficiaries who cannot afford their Medicare
cost-sharing obligations," Thompson said (Appleby, USA Today,
2/20). Dara Corrigan, acting principal deputy inspector general
at HHS, said that hospitals could reduce or eliminate copayments
and deductibles that would create financial hardship for a
Medicare beneficiary. Corrigan said that hospitals can define
"financial need" based on local costs of living and the
beneficiary's income, assets and medical bills. She added that
the hospital's criteria should be applied consistently to all
patients. Corrigan said that while hospitals can advertise
discounts available for uninsured patients, they cannot offer
discounts "as part of any advertisement or solicitation"
designed to attract Medicare beneficiaries or to generate
business payable by Medicare or other federal health programs
(Pear, New York Times, 2/20).
Hospital Reaction
Rick Wade, a spokesperson for AHA, said that Thompson's response
answered only some of AHA's questions, the AP/Las Vegas Sun
reports. "When a hospital sets a policy on the indigent, it will
not accommodate every case that comes through a door," Wade said
(Sherman, AP/Las Vegas Sun, 2/19). Melinda Hatton, AHA vice
president, said, "It's still not entirely clear what hospitals
can do to help the working poor," adding, "How much of a
discount can they give to a family of four with income of more
than $37,000 a year?" (New York Times, 2/20). Chip Kahn,
president of the Federation of American Hospitals, said that
Thompson's letter could be "a useful roadmap." He added that the
"substantive guidance should help end confusion and enable
hospitals to continue their efforts to address this problem on
which we have a shared concern" (Dorschner, Miami Herald, 2/20).
Laura Wegscheid, a spokesperson for Colorado-based Centura
Health, said that hospitals are waiting for guidelines on how
exactly they can provide discounts and financial assistance to
uninsured patients who have annual incomes higher than the
federal poverty level; the guidelines are due for release next
year, the Post reports (Denver Post, 2/20).
Advocate Reaction
Elisabeth Benjamin, an attorney for the Legal Aid Society, said
that Thompson's letter "finally puts to rest the hospitals'
tired and inaccurate argument that the government made them
charge uninsured and underinsured people these crazy inflated
prices" (Wall Street Journal, 2/20). K.B. Forbes, executive
director of the Council of United Latinos, said, "We are very
pleased with Secretary Thompson's letter. It's now clear that
hospitals can offer discounts to the uninsured, including
working-class families who earn too much to qualify for charity
care, but not enough to pay their medical bills" (New York
Times, 2/20). James Tallon, president of the United Hospital
Fund, said that Thompson's letter is a good "template" because
"there was ample room for criticism of hospitals' behavior."
However, he added that "hospitals were genuinely confused by the
thicket of federal regulations" (Wall Street Journal, 2/20).
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---------------------------------------------Take care...
Greg Lunger
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