Re­port: Char­ity care a shell game

Re­port on hos­pi­tal pol­icy dis­clo­sures ill-timed: AHA

Modern Healthcare - - Front Page - Joe Carl­son

Just as tax-ex­empt hos­pi­tals across the coun­try are pre­par­ing to meet a new fed­eral man­date dic­tat­ing how they ad­ver­tise their char­ity-care poli­cies, a pub­lic ad­vo­cacy group has re­leased a re­port say­ing many hos­pi­tals in the coun­try are fail­ing to meet even the ba­sic vol­un­tary stan­dards al­ready in place.

Re­searchers from the Bos­ton-based Ac­cess Project and Com­mu­nity Cat­a­lyst say their re­port points to a clear need for strict char­i­ty­care reg­u­la­tions that are only now be­ing de­bated by fed­eral of­fi­cials as part of the rule­mak­ing process fol­low­ing pas­sage in March of the Pa­tient Pro­tec­tion and Af­ford­able Care Act.

How­ever, the Amer­i­can Hos­pi­tal As­so­ci­a­tion, which is heav­ily crit­i­cized in the re­port, says the study comes at a cu­ri­ous time as many of the al­leged prob­lems high­lighted in the re­port are al­ready un­der close scru­tiny by the In­ter­nal Rev­enue Ser­vice. The pub­lic is about to re­ceive an avalanche of stan­dard­ized data on hos­pi­tal char­ity-care poli­cies as hos­pi­tals meet the statu­tory dead­lines to file their newly en­hanced Form 990 tax dis­clo­sures.

“I think it’s out of sync with the fact that the in­dus­try has been mov­ing to­ward these prac­tices any­way,” said Melinda Hat­ton, se­nior vice pres­i­dent and gen­eral coun­sel at the AHA. Sec­tion 9007 of the health­care law says that in or­der to qual­ify for tax-ex­empt sta­tus, a hos­pi­tal must have a writ­ten fi­nan­cial as­sis­tance pol­icy that in­cludes: spe­cific el­i­gi­bil­ity for free or dis­counted care, the ba­sis and meth­ods for cal­cu­lat­ing those charges, what ac­tions the hos­pi­tal may take in the case of non­pay­ment, and mea­sures to “widely pub­li­cize the pol­icy within the com­mu­nity to be served.”

The Ac­cess Project study, Best Kept Se­crets: Are Non-Profit Hospi- tals In­form­ing Pa­tients About Char­ity Care Pro­grams?, was re­leased last week al­most ex­actly five years af­ter an ear­lier re­port reached sim­i­larly crit­i­cal con­clu­sions. The new re­port found that in 2009 only 57 of 99 hos­pi­tal web­sites re­viewed even men­tioned the avail­abil­ity of char­ity care. And only nine of the 99 hos­pi­tals said on their web­sites specif­i­cally how much in dis­counts is avail­able to needy pa­tients based on vary­ing in­come lev­els.

In fol­low-up phone calls by Ac­cess Project staff, ev­ery one of the 73 hos­pi­tals where a con­tact per­son was reached ac­knowl­edged that the hos­pi­tal had a char­ity-care pol­icy. How­ever, only 23 of the hos­pi­tal of­fi­cials could pro­vide an ac­tual ap­pli­ca­tion for char­ity care, while an­other 15 said they would send an ap­pli­ca­tion but never did.

The vol­un­tary AHA guide­lines on hos­pi­tal billing and col­lec­tion prac­tices, which have been signed by 4,200 com­mu­nity hos­pi­tals na­tion­wide, say hos­pi­tals should pro­vide fi­nan­cial coun­sel­ing to pa­tients about their hos­pi­tal bills and “make the avail­abil­ity of such coun­sel­ing widely known.” Hos­pi­tals should also make their prices for fi­nan­cial-as­sis­tance pa­tients “avail­able for re­view by the pub­lic,” but the AHA guide­lines don’t spec­ify how that should be done.

“The AHA has long main­tained that the vol­un­tary guide­lines are suf­fi­cient,” said Carol Pryor, se­nior pol­icy an­a­lyst at the

Townsend: “We stream­lined the process.”

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