Bedside counseling helps hospitals get paid for care

06/02/2013 7:26 AM

08/08/2014 10:17 AM

Rhonda Schippers spends a lot of time with hospital patients.

But she’s not a nurse or a doctor.

Schippers is a financial counseling coordinator for Via Christi hospitals and goes to the bedside of patients who are underinsured or uninsured to talk about how they will pay for their care.

“We screen patients at the bedside to see what we can do to help them apply for public benefits or other programs, like our in-house financial counseling program,” Schippers said.

Patients aren’t as receptive through phone calls and letters, Schippers said, but they do respond to the in-person visits. If they aren’t eligible for public benefits but have limited ability to pay, she will see if they are eligible for charity care.

“It helps them relieve some stress so they can concentrate on getting well,” she said.

Every year, local health care providers donate millions of dollars of care to the underinsured and uninsured.

Local figures

Via Christi’s 2012 figures, which were reported earlier this year, include $46.8 million in charity care, $21.7 million in unpaid costs of Medicaid services and $22 million in other community services.

As a nonprofit system using guidelines set by the Catholic Health Association, Via Christi Health’s numbers are reported costs, not charges, for services. Unpaid and uncollected bills and unpaid costs of Medicare are not included, system officials said.

If the system used the American Hospital Association guidelines, which include bad debt and unpaid Medicare costs, its benefit would total $124.4 million, officials said.

Wesley Medical Center provided a total of $146.6 million in donated care in 2012, said Chief Financial Officer Matt Leary. That number includes $11.8 million in charity care, $28.2 million in bad debts and $106.6 million in discounts for the uninsured.

The hospital defines “bad debt” as the money it writes off “when a patient can’t demonstrate financial hardship but still refuses to pay and/or patients that won’t complete the charity paperwork and don’t pay,” Leary wrote in an e-mail.

It can be a lengthy process to receive charity care, Leary said in an interview. And staff at Wesley also speak with patients about their eligibility for federal and state assistance programs, such as Medicaid.

There are some people, often referred to as “working poor,” who do not qualify for Medicaid in Kansas but still can’t afford to pay their hospital bills, he said.

“Depending on where they fall, we then offer a 50 percent additional discount to 100 percent write off if they meet that highest level of the federal poverty level,” he said.

As a for-profit entity, Wesley is able to write off the cost of donated care for tax purposes, but it receives no additional tax incentive for the care, Leary said.

For nonprofit hospital systems such as Via Christi, charity care figures help determine nonprofit eligibility, said Nancy Ketchum, patient access director for Via Christi hospitals in Wichita.

Changes in health care

The amount of uncompensated care for the uninsured also helps determine the amount of federal Disproportionate Share Hospital funding that goes to hospitals – nonprofit and for-profit – to help offset the cost of care for the underinsured and uninsured.

However, as part of federal health care laws passed in 2010, hospitals agreed to DSH funding cuts in exchange for an expansion of the Medicaid program.

In states such as Kansas, which hasn’t acted to expand Medicaid, hospitals could be hit hard as the federal government institutes those cuts.

Wesley’s Leary said he doesn’t see the amount of donated charity care going down anytime soon.

“The biggest concern for us is the fact that the state has not really supported Medicaid expansion,” Leary said.

No expansion, paired with the federal requirement for nearly everyone to have some sort of coverage, will likely mean increased charity care, he said.

Ketchum agreed, saying it’s difficult to foresee the impact, but charity care is “absolutely not going to go down.”

Officials from both hospitals said the biggest immediate impact on charity care is the local economy, specifically with layoffs in the aircraft and manufacturing sectors.

Via Christi’s Ketchum said, “With the aircraft layoffs 10 years ago, you went back to work in a few months, but you don’t see that as much now.”

“We do see a lot of people where it’s their first time without insurance, and they don’t know what to do,” said Nora McVicker, manager of financial counseling for Via Christi Hospitals Wichita. “So people wait. ‘I don’t have insurance, I can’t go to the hospital,’ and they are ill and postpone care. … It leads to a bigger bill.”

Project Access

An offshoot of the Medical Society of Sedgwick County, Project Access matches patients who do not have health care benefits with providers who are willing to donate their services.

Started by Dr. Paul Uhlig in 1999, the program has overseen donations worth more than $146 million and served more than 11,500 patients. It oversees about $16 million in donated care annually.

In addition to the hospitals, 183 primary care physicians and 430 specialists participate in the program. An estimated 75,250 uninsured people live in Sedgwick County.

“Uninsured people are charged at a higher rate than any other patient population. The bill they get is the highest possible bill,” said Anne Nelson, associate executive director of Central Plains Health Care Partnership, which runs Project Access. She was referring to prices charged by hospitals and other providers. Usually, those without any insurance are charged substantially higher prices than those who have insurance or Medicaid because insurance companies negotiate lower prices for services and the government sets payment rates for services provided to Medicare and Medicaid patients.

“An uninsured person is on his or her own. They are not in a position to negotiate their rates unless they meet with staff at the hospitals and explain their income situation and try to negotiate a lower charge.”

Most of the patients in the program are referred by local safety net clinics, Nelson said.

Joe Davison, a family physician at West Wichita Family Physicians, has regularly donated services to Project Access patients since the program began in 1999.

Davison said he likes the program because it allows him to donate his time at his own office, and he doesn’t have a lot of time to drive to charity clinics around town.

“It makes patients, when they come into the office, just like all the others,” he said. “They’re treated the same. It’s the same care.”

He said the typical Project Access patient has a job but no health insurance.

“They’re just people trying to get along and make ends meet,” he said. “For a few people with very serious illnesses, without (the program), they would go bankrupt. The leading cause of bankruptcy is medical expenses. This is a very good program for our city.”

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