Monday, February 02, 2004

In today's Wall Street Journal (subs. req.), partly to avoid the wrath of the New York State Legislature and this man, hospitals in New York are willing to take their chances with Medicare and provide discounted pricing to the uninsured:

Amid mounting criticism of hospitals' treatment of the uninsured and warnings of tough legislative remedies, hospitals in New York state have agreed to a voluntary program to cut prices and provide charity care for their poorest patients. They have also pledged to restrict punitive collection tactics.

The trade group representing the state's 230 not-for-profit hospitals -- ranging from state-of-the-art teaching facilities in Manhattan to small hospitals in economically depressed towns upstate -- quietly adopted the program two weeks ago following seven months of wrangling........The New York guidelines urge hospitals to offer immediate price cuts to anyone who makes 200% or less of the federal poverty level of roughly $9,000 a year for an individual. They also encourage institutions to offer discounts to families who earn more. In particular, the guidelines steer hospitals away from billing the uninsured at full charges, suggesting instead that they charge low-income patients the far lower amounts they receive from HMOs, insurers and the government.

The guidelines also specifically discourage such collection measures as home foreclosure and "body attachment," a practice under which a hospital has a patient arrested and jailed for missing a court appearance related to a medical debt.

As with all good compromises both sides are unhappy:

Participants in the process recall testy discussions over discounts. Some hospitals wanted the bare minimum threshold, perhaps 150% of the poverty level, while others wanted to go as high as 400%. And some didn't want any fixed number.

New York City hospitals, which have their own trade group, were resistant to the whole idea of statewide guidelines at first. "Frankly, there was a debate whether or not if you published a policy it would push you in the direction of legislation," says Kenneth Raske, president of the Greater New York Hospital Association. He and some of his members also worried that guidelines would be "a floor, not a ceiling," though they eventually embraced the policy.

Hospital-critic Elisabeth Benjamin of the Legal Aid Society reacted favorably to the new guidelines, though she says, "They can still charge 9% interest, they can still grab your paycheck, they can still sue you, they can put liens on your house." She also believes that legislation will still be necessary to regulate hospital practices, and that the 200% threshold is too low. But she says she's pleased that "New York hospitals have finally woken up," and that even 200% will help young singles and childless couples, who often fall through the cracks because they don't qualify for Medicaid or other government programs.

I wonder what Medicare will do?
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