Second House Subcommittee Examines
Hospital Billing and Collection Policies
July 2, 2004 - Representatives from healthcare systems,
consumer groups, and policy research organizations addressed various
concerns regarding hospital billing and collection practices related
to the uninsured at a June 24 hearing before the Energy and Commerce
Subcommittee on Oversight and Investigations. The Ways and Means
Subcommittee on Oversight conducted a similar hearing on June 22
[see Washington
Highlights, June 25].
In a statement issued the day of the hearing, Energy and Commerce
Committee Chairman Joe Barton (R-Texas) reported he was "encouraged"
that the hospital industry had "taken recent steps to revisit
and enhance" billing and collection practices. "However,"
he warned, "we all know policies can be little more than talk…the
proof is in the results." Chairman Barton said he looked forward
to hearing "how your commitments have taken action" in
terms of helping uninsured patients meet their "fair [financial]
obligations" in a "fair and respectful manner."
Similarly, Oversight and Investigations Subcommittee Chairman Rep.
Jim Greenwood (R-Pa.) challenged the hospital industry to uniformly
adopt the billing/collection principles and guidelines issued by
the American Hospital Association (AHA) earlier this year. He suggested
that widespread adoption of reasonable practices might avert legislative
action on the issue.
Praising the adoption of the AHA principles and guidelines as a
good first step, witnesses
from the Johns Hopkins School of Public Health and The Access Project
(an advocacy group affiliated with the Brandeis University School
for Social Policy and Management) proposed further strategies for
easing the financial pressures faced by poor, uninsured patients.
Hopkins Professor Gerard Anderson, Ph.D., supported a change in
the methodology used to set hospital charges. Dr. Anderson suggested
that charges reflect Medicare levels, plus 25 percent. He explained
the level "is above what insurers are paying…it is a reasonable
amount," adding that such a methodology "is transparent"
and "easy to monitor and verify."
Mark Rukevina from the Access Project argued that hospitals should
offer uninsured patients the same discounts extended to insured
patients. He added that all hospitals should screen uninsured patients
for public assistance eligibility, and partner with patient advocacy
groups to educate needy patients about charity care and other payment
options available in the community. "Hospitals must take a
proactive role in informing their patients of charity care,"
Mr. Rukevina advised, "and they must stop aggressive collection
actions against uninsured patients." Additionally, Mr. Rukevina
challenged the AHA to "build upon" its guidelines and
principles by developing a financial assistance initiative for uninsured
patients. He also recommended that hospitals be held accountable
for how they spend Medicaid DSH payments and other uncompensated
care funds.
Herbert Pardes, M.D., president and CEO of New York Presbyterian
Hospital/Columbia Presbyterian Campus and former chairman of the
AAMC, also testified before the Subcommittee. Dr. Pardes provided
an overview of his organization's billing policies, including a
commitment to providing free care or reduced charges for individuals
with incomes below 300 percent of the Federal Poverty Level. Tenet
Healthcare Corporation President and CEO Trevor Fetter informed
the Subcommittee that his organization was pursuing a new billing
policy for the uninsured in which charges would reflect 75 percent
of average managed care rates. Similarly, HCA Chairman and CEO Jack
Bovender, Jr., reported that his company was considering setting
rates for the uninsured at 95 percent of managed care rates. Both
explained that such changes represented long-term, not immediate,
strategies. Arguing that coverage was the best way to assure individuals
could pay for their healthcare, Mr. Bovender also expressed support
for mandated employer coverage and health insurance for the unemployed.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
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