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Hospitals are faced with a dilemma. An estimated 45 million Americans have no health insurance, and millions more have inadequate coverage that leads to difficulties in paying for health services. The burden of providing access to health services for uninsured and underinsured patients has fallen substantially on hospitals, public health departments, and community health centers. Hospitals are committed to their communities and carry out missions that include significant charity services. And all hospitals with emergency departments are required by law to provide certain emergency services to anyone, regardless of ability to pay.

At the same time, hospitals are expected to operate in a financially responsible manner and manage limited resources effectively. Balancing patient needs and stakeholder expectations while operating in a dynamic regulatory and market environment creates major challenges for hospitals. A fundamental challenge for hospitals, given these conflicting demands, is how to best identify patients who are unable to pay and establish payment expectations for those who are able to pay.

To better serve patients, many hospitals are evaluating their discounting and collections policies and practices for services to the uninsured and underinsured. The PATIENT FRIENDLY BILLING[R] project has developed tools and is sharing knowledge and practical ideas to help hospitals and health systems revise their policies and procedures and implement those revisions quickly and effectively.

Hospitals, patients, and policy-makers have struggled with a range of multifaceted and complex issues as a result of the framework of state and federal regulations and third-party contracting in which hospital charges were traditionally set. Discounting and collections policies for uninsured and underinsured patients vary significantly across hospitals in the United States, so, when revising them, hospitals should take into consideration the unique needs of their organizations and communities. Complicating the issue further are environmental factors, such as the nation's lack of a solution to the growing number of uninsured and underinsured patients; regulatory factors, such as regulatory barriers to changing hospital discounting and collections policies; and hospital factors, such as whether hospital policies and practices meet the needs of the organization and the people it serves.

Key Questions to Address When Evaluating Policies

These challenges require hospital leaders to address numerous significant issues when reviewing or changing current policies and practices related to discounting and collections for care provided to uninsured and underinsured patients. Following are some questions hospitals can use as tools to guide this process. By addressing these questions, hospitals can develop responsible, balanced policies and practices that assist uninsured and underinsured patients:

* Who qualifies for discounted or free care?

* What services are discounted?

* What discount levels are offered?

* How are policies communicated?

* How are unpaid patient accounts resolved?

* What structures and systems are in place to implement and administer policies effectively?

* What is the relevant legal and regulatory context?

The Patient Friendly Billing web site (www.patientfriendlybilling.org) contains a convenient checklist that hospitals can use to make sure they have considered the different aspects of each question, evaluate their current status, and help identify appropriate changes.

Lessons Learned by Hospitals That Have Revised Their Policies

Interviewed hospitals that recently have made changes to their policies offer the following advice for other hospitals contemplating policy changes.

Policy characteristics

* The most effective policies are simple, clear, and written with the patient in mind.

* It is helpful if the policies allow some flexibility; for example, recent pay stubs may indicate income slightly over the discount policy guidelines, but the patient says his work hours have recently been reduced.

Involvement of others

* Including the community in the process can lead to success.

* Hospitals that involve eligibility vendors, collection agencies, and others with a role in the process in designing policies and procedures have fewer implementation problems.

Training, implementation, and monitoring

* Implementation plans need to allow sufficient time to develop and test patient education materials (brochures) and to conduct necessary staff training.

* Hospitals that train frontline staff to discuss payment before the patient leaves the hospital (particularly for prescheduled services) can minimize the need for collection activities.

* An extended business office can focus on self-pay accounts, be responsive to uninsured patients' needs, and promote effective policy implementation.

* Hospitals may find it helpful to track and analyze the impact of policy changes; automated solutions can support this process.

# posted by Medical Information : 2:31 AM