Readers Speak Out On Hospital Debt Collection

SPEAK OUT

January 03, 2009

Hospitals often wind up with stacks of unpaid bills because of the lack of universal health insurance coverage in this country. And certainly, no one likes to receive a letter or call from a bill collector or go to court over a hospital charge. Yet hospitals can only survive if bills get paid.

That was one of several key points missing from The Baltimore Sun's series "In Their Debt" (Dec. 21-23).

At the same time, hospitals aren't anxious to litigate. Few disputes make it to court: less than 0.5 percent of all hospital bills.

A second missing piece: Most cases go to court as a result of lack of communication.

Unless patients talk with the hospital and provide information, we can't determine if they have the resources to pay or connect them to programs such as Medicaid.

Then there are the people who have the means to pay but seek to evade their obligations. That's not fair to everyone else.

Last year, Maryland hospitals provided $260 million in charity care, on top of $600 million in care to those who could not or would not pay their bills.

The Baltimore Sun's series suggests hospitals shouldn't pursue patients because hospitals already get reimbursed for unpaid bills through Maryland's rate-setting system. That's not an accurate portrayal of how the system works.

A state panel uses a formula to project future reimbursements to hospitals for uncompensated care. These subsidies vary from one year to the next and are sometimes higher and sometimes lower than the actual costs.

And in the last two years, Maryland hospitals received less than the actual cost of delivering unpaid care.

All paying patients in Maryland share equally in supporting this system through charges on their bills. And if Maryland hospitals made no bill-collection efforts, charges for all of us would be far higher.

The series ignored the crux of the problem: 800,000 people in Maryland lack adequate health insurance. Yet people still get sick and hospitals continue to provide care to everyone.

Gov. Martin O'Malley and our legislators have set our state apart by expanding health care coverage to more low-income families. Still, significant gaps in coverage remain.

Without a national policy providing health care coverage for all, the chasm between our health needs and our ability to pay will grow.

That dumps the problem on hospitals, which must patch together care and coverage one patient at a time.

Carmela Coyle, Elkridge

The writer is president and CEO of the Maryland Hospital Association.

A longer version of the Maryland Hospital Association's response to the "In Their Debt" series can be seen at baltimoresun.com/opinion.

I thank The Baltimore Sun for an informative series on the Maryland hospital rate-setting system. And in thinking about the series, several points are important to consider:

* The Maryland Health Care Cost Review Commission has kept Maryland hospital charges carefully modulated. There are no extremes in the profits or losses for Maryland hospitals, and hospital fees in Maryland are lower than those in most states. This is a success that warrants our gratitude to the leaders of the system.

* Hospital finances are very complex, and many hospital billing systems are incomplete and inaccurate. That problem should be fixed.

* Hospitals vary in their policies regarding the collection of unpaid bills. Each hospital must determine whether its practice is consistent with the public trust with respect to both individual patients and insurers. Uncompensated service costs are passed on to other insurers through higher rates, and collections help reduce the cost to other payers by lowering lower rates.

* Two issues are important to improving health care while controlling health care costs: the crying need for universal health care insurance so that every American has some form of coverage, and the need to improve access to high-quality primary care, which is known to help control the cost of care.

Dr. John R. Burton, Baltimore

The writer is a professor of medicine at the Johns Hopkins School of Medicine.

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