Reading Hospitals-don't-explain

Hospitals Fail to Explain Aid Available to Poor, Report Says

October 2, 2003

Each year, New York's hospitals receive $847 million from
Albany to offset the cost of caring for people who do not
pay their bills - usually the poor and uninsured.

But most hospitals do a bad job of explaining to patients
that such assistance exists and whether they qualify, and
many of them make it hard for patients to apply, according
to a report released yesterday by a nonprofit group.

The group, the Public Policy and Education Fund, is an arm
of Citizen Action of New York, a liberal advocacy
organization. The report found in interviewing officials at
70 hospitals around the state that only one-third could
produce a written policy describing their indigent-care
programs, that some others could describe the policy only
verbally, and that others would not give any description.
Some of the written policies say who is eligible, based on
income, and what services are covered, but most do not, and
some hospitals said that such decisions are made case by
case, the report said.

In nearly every case, the group reported, getting the
information was an ordeal requiring great persistence, with
multiple calls over many days, bouncing from one office to
another, trying to find someone to answer simple questions.

As the report makes clear, there is no federal or state law
requiring hospitals to care for people who cannot pay,
except for emergencies - though nearly all hospitals in New
York do so, to some degree.

For hospitals that have such programs, no law sets
standards for who is eligible, what treatment is covered,
or how the paperwork should be handled.

"If you're a consumer who's been sent to collections and
your credit rating is getting ruined and you can't pay,
sometimes the hospital will tell you it has a charity care
program and sometimes it won't, and sometimes it'll make it
clear to you what the rules are, but usually it won't,"
said Richard Kirsch, executive director of Citizen Action
of New York.

Patricia J. Wang, senior vice president of the Greater New
York Hospital Association, said she believed that the
report overstated the problem. Still, she said, she would
not be surprised if practices differed widely by hospital,
or if, in some cases, hospitals did not explain their
policies well to their patients.

She said her group, which includes nearly all the hospitals
in downstate New York, would take up the report's findings
with its members, because "we think that if there's a
communication problem, we need to fix that."

But, she added, "This report evaluated hospitals against an
ideal that Citizen Action believes should exist."

In part, the group based its standard on laws in a few
states, particularly Massachusetts, that require hospitals
to inform patients, in writing, of that state's charity
care program and to explain what that program does.

The report criticized hospitals for sending bills to
patients even as they were processing their applications
for coverage by an indigent-care program. Ms. Wang said,
however, that the state required hospitals to be aggressive
about trying to collect on bills, or risk losing aid.

In New York, state law puts a surcharge on every hospital
bill, and that money goes into a state-controlled fund. The
money is used primarily to reimburse hospitals for caring
for the poor, but to some extent it also helps them
compensate for people who simply do not pay their bills,
even if they are able to do so. The state distributes the
$847 million to the hospitals each year based on what
proportion of their bills go unpaid.

New York's hospitals say they have $2.5 billion a year in
unpaid bills. The state says the actual cost to the
hospitals of providing that care is about $1.7 billion, so
the charity care fund covers only half the total.