Saturday, January 31, 2004

Some in south Florida feel they are the victim of price gouging at their local Miami hospital.

Decrying hospitals for charging the uninsured up to six times what insurance plans pay, a consumer group issued its final report Thursday on Miami-Dade County, saying that it had received the most complaints about Kendall Regional Medical Center.
''There's no reason they should gouge patients like this,'' said K.B. Forbes, head of Consejo de Latinos Unidos, a California-based group.
One example at the press conference: Rina Murillo, a 33-year-old unemployed mother suffering from kidney stones who ran up a $25,000 bill over five days at Jackson Memorial and then was billed about $45,000 later for several out-patient treatments. She never had surgery.

The hospital position is as expected, but this fight is nastier than most:

Linda Quick, president of the South Florida Hospital and Healthcare Association, questioned Forbes' motivation in a telephone interview. ''He needs to be confronted,'' she said.
``His goal does not appear to be to help people get insurance, but to get them free care, or cheap care. That's not working to solve the problem.''
She said evidence indicated Forbes is using a Hispanic-sounding group as a front to help health insurers get lower prices. Forbes denies the charge.
Quick said hospitals locally and nationally are working to find ways to deal with the uninsured, which she dubbed ''a national crisis.'' Her group has ``a number of committees that continue to study this complex issue.''

The hospital in question Kendall Regional Medical Center , according to Mr. Forbes, is not shy about taking their patients to court.

In a press conference, Forbes said that, of all the hospitals in Miami-Dade, Kendall Regional had the greatest tendency to sue patients to recover unpaid sums. His survey showed that Kendall had filed 248 lawsuits in 2003 -- a seven-fold increase from the 34 lawsuits it filed in 2000.

But apparently they don't go so far as to throw their patients in jail. The CEO makes his point as plainly as possible:

Everyone gets charged the same at Kendall Regional, Sirvent said, though health plans negotiate smaller charges for their members.
''We don't have a contractual relationship with the uninsured,'' he said, adding that the hospital had to write off $275 million worth of care to the uninsured over the past three years.

As I have posted earlier (here, here, and here), hospitals and physicians are somewhat limited in any discounting that can be offered to uninsured patients due to potential conflicts with Medicare. Hospitals are taking notice:

Forbes' report on Miami-Dade did not include Tenet hospitals, he said, because Consejo and Tenet reached an agreement a year ago that uninsured persons who entered through emergency rooms would be charged managed-care rates.
That agreement has yet to be implemented, because Tenet is seeking clarification from the federal government whether it would affect its Medicare charges......

Meanwhile, closer to home, Grady Memorial Hospital tells us, if you're uninsured but not from Fulton or DeKalb counties, bring your wallet.

Grady Health System will stop providing primary care services at no cost to uninsured people who live outside Fulton and DeKalb counties.
Instead, patients will be expected to pay up front for standard clinic and office visits, beginning April 1, said Dr. Andrew Agwunobi, Grady's chief executive....."We have become the hospital for the uninsured without any boundaries on where patients live," said Agwunobi, a pediatrician-turned-budget-surgeon who previously pulled South Fulton Medical Center from the edge of bankruptcy. "Grady Health System is not a dumping ground for other counties or other hospitals."

According to the administration, Grady cannot continue to support uninsured residents from other counties who have been content to allow their uninsured to receive their medical care at Grady.

"I've been watching the bills pile up for 16 years, attending the Hospital Authority meetings," said state Rep. Doug Teper, a Democrat who represents parts of DeKalb and Fulton counties. "There's really never been a good mechanism in place to pay for out-of-county people. It's a challenge just to make sure the [address] information is correct, that patients really are from where they say they're from, let alone figure out who's going to cover costs."

A new system of identifying patients should help quickly determine an individual's address and insurance coverage. On Jan. 1, Grady began issuing silver "Grady Care" cards that resemble credit cards. Only DeKalb and Fulton residents who are uninsured and who have a proven place of residence are eligible for the cards. Medicaid, Medicare and privately insured patients don't need the card.

Some are concerned that by closing out the outpatient clinics could shift those patients to the emergency department. According to the article, they have a plan...

All emergency patients must pass through the triage process, which sorts out the severity of medical attention required and assesses eligibility for care, she said.

"Should out-of-county uninsured individuals show up in the emergency room with ailments deemed minor by triage nurses, such as a cold or heartburn, they'll be referred back to the clinic," Simpson said.

Hopefully the people at Grady will know the difference between a triage evaluation and the EMTALA mandated "medical screening exam".

Thanks to Ross for the Miami link.
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