Many Hospitals Seek Bill Payment Before Discharge, Wall Street Journal Reports
The Wall Street Journal on Wednesday examined a "more aggressive billing stance" at an increasing number of U.S. hospitals that requires patients who seek nonemergency care to pay at least part of their bills before they leave -- or before they receive treatment in some cases -- as part of an effort to reduce bad debt. According to the American Hospital Association, debt from unreimbursed care totaled $22.3 billion at 4,927 U.S. hospitals in 2002, the last year for which data are available. Although hospitals cannot collect a large part of the debt because many patients cannot afford to pay, some debt results from patients with health insurance who fail to pay out-of-pocket expenses not covered by their policies. Hospital administrators maintain that the collection of at least a small part the debt attributable to patients with health insurance would "make a significant difference to their bottom lines," according to the Journal. Several studies have found that hospitals have more success with debt collection when they require patients to pay before they leave than when they bill patients several months later. Carmela Coyle, AHA senior vice president for policy, said that hospitals face different problems with debt collection than other consumer service providers because "hospital debt isn't something the patient wants to incur, so it creates a different feeling around the obligation."
Later this month, Tennessee-based HCA, the largest U.S. for-profit hospital chain, will begin to require patients to make copayments before they receive nonemergency care. In the event that patients cannot pay, HCA hospitals will require at least a down payment. HCA officials said that such a down payment will help establish "the principle of patient responsibility and pave the way for additional payments after a patient returns home," the Journal reports. About 25% of the $2.2 billion in bad debt that HCA incurred in fiscal year 2003 resulted from uncollected copays from patients with health insurance. California-based Tenet Healthcare, the second-largest U.S. for-profit hospital chain, has begun a pilot program in Florida in which hospital administrators use the Internet to determine patient copays and deductibles to help improve bill collection. In addition, Andrew Agwunobi, president and CEO of Grady Health System, the largest public hospital in Georgia, said that the facility in January began a program to contact elective-surgery patients before treatment to inform them of their copays "to increase our ability to collect from those with insurance." Other hospitals have begun to send collection agents to patient rooms to discuss copays and send patients through the business office before they leave to pay bills or establish payment plans. According to the Journal, none of the hospitals has sought payments from patients before they receive emergency care, and "none of these programs is resulting in denial of services." However, hospitals remain "wary of criticism from consumer activists who have attacked aggressive collection efforts by some institutions during recent years," the Journal reports (Rundle/Davies, Wall Street Journal, 6/2).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.