Front Street Hospital Case Study Essays

Front Street Hospital Case Study Essays Front Street Hospital Case Study Essay Front Street Hospital Case Study Essay According to Kaiser Family Foundation (2013), more than 47 million Americans were uninsured in 2012. These gaps in health insurance undoubtedly increase healthcare costs, discourage the use of preventative care, and negatively impact the lives and health of the American people. One way to combat this issue is for hospitals and providers to offer charity care to those who qualify and are in need. Non-profit hospitals are organized to serve a charitable purpose to meet the needs of the community and serve indigent patients that would otherwise go without care due to lack of insurance. In return, these organizations receive tax exempt status on  all of their earnings. However, some hospitals have fallen short in terms of fulfilling their obligations to the community and the patients in need. The revenue function of healthcare organizations is extremely complex. Part of this issue can be attributed to the different sources of revenue payers: self-pay, Medicare, Medicaid, commercial insurance, and managed care contract payers. Health economist Gerard Anderson notes that â€Å"uninsured patients and those who pay with their own funds are charged 2. 5 times more for hospital care than those covered by health insurance and more than 3 times the  allowable amount paid by Medicare† (Anderson, 2007). : Front Street Hospital has most certainly contributed to those staggering figures researched by Anderson. For example, Jane Adams, a young uninsured patient spent two days at Front Street for an appendectomy procedure. An insured patient undergoing the same procedure would have been expected to pay close to $2500 after Medicare and Medicaid reimbursements to the hospital. Instead, Adams was left with a $19,000 bill for the appendectomy. Like all other uninsured patients, Adams didn’t benefit from discounted rates. To add insult to injury, Front  Assignment 6. 2 Chapman 3 Street is known for its intimidating collection tactics against patients who are unable to finance their care. Similarly there is Lori Duff, an uninsured Ohio resident who was barely able to make ends meet. After seeking treatment and not being able to pay her hospital bill, she was threatened with a 25% wage garnishment and continuously harassed by Mount Carmel Health System. Being a part of the uninsured population I empathize with self-pay and uninsured patients. Many people delay treatment to avoid outrageous bills and the financial burdens associated with them. So, I completely disagree with the billing and collection policies of non-profit hospitals related to the uninsured. The uninsured patients are the ones who need discounted services most. It creates a catch 22 situation when choosing to seek care. Avoiding care will only deteriorate an individual’s health, while seeking care creates financial problems. I don’t believe that hospitals should not try to collect on past due bills; however they should go about it in a different way than Front Street has. The Fair Debt Collection Practices Act grants creditors the ability to seek to collect on outstanding debt in a number of ways (FTC,2014). Hospitals are known for providing a substantial amount of uncompensated care and it is their job to reduce these types of liabilities. Therefore, Front Street was not unethical in their efforts to collect debt through communications with the patients. I disagree with how far they have chosen to go to collect on bad debt and believe that there are different methods that could have been used. If I could act as the ultimate authority in this situation I would create a stringent law that requires hospitals to fairly set prices for uninsured patients, monitor compliance, and add  penalties for those who disregard the law. Thankfully the new healthcare reform has addressed Assignment 6. 2 Chapman 4 the issue related to hospitals and their obligation to provide charity care. Under the new rules nonprofit hospitals are required to comply with the following four provisions (Gold, 2012): 1. Prohibited from charging uninsured low-income patients higher rates than the lowest amounts billed to individuals with insurance. 2. Required to have a clearly written financial assistance policy describing who is eligible for free or reduced cost care. The policy must be widely publicized in the community  served by the hospital. 3. Prohibited from enforcing extraordinary collections actions against patients before determining whether the patient qualifies for financial assistance. 4. Required to conduct assessments on the health needs of the community they serve and implement a strategy to meet those needs. One thing that I would focus on due to my experience is closely monitoring how well hospitals implement their financial assistance policies. A few years ago I was denied assistance for an emergency room visit and without being given any explanation as to why. Based on my  understanding of the policy, I qualified for assistance, however, my bill was never reduced and it eventually went to collections. I would also reevaluate the needs of the community and see how the organization can meet those needs. It is important to educate the community on the organization’s obligations to the patients and community, patient responsibilities, and ways to utilize available resources. Many patients don’t know about the financial assistance policies that hospitals have. This creates a huge disconnect between the patient and the hospital or providers treating the patient. Assignment 6. 2 Chapman 5 References  Anderson , G. (2007). Hospitals charge uninsured and â€Å"self-pay† patients more than double what insured patients pay. Retrieved from jhsph. edu/news/news-releases/2007/anderson-hospital-charges. html Federal Trade Commission (FTC) (n. d. ). Fair Debt Collection Practice Act. Retrieved on August 5, 2014 from ftc. gov/enforcement/rules/rulemaking-regulatory-reform-proceedings/fair-deb t-collection-practices-act-text Gapenski, L. (2010). Cases in healthcare finance. (4 ed. , pp. 239-241). Health Administration Press. Gold, J. (2012, April). Nonprofit hospitals faulted for stinginess with charity care. Retrieved from npr. org/blogs/health/2012/04/27/151537743/nonprofit-hospitals-faulted-for-st inginess-with-charity-care Kaiser Family Foundation. (2013, October). The uninsured: A primer key facts about health insurance on the eve of coverage expansions. Retrieved from http://kff. org/uninsured/report/the-uninsured-a-primer-key-facts-about-health-insurance-o. n-the-eve-of-coverage-expansions/ HCM 733 Domonique Chapman Case Study: Front Street Hospital, Week 6 Learning Outcomes: advocate courses of action regarding finance-related ethical issues in health services organizations. Score  Below Expectations 0 – 10 Approaches Expectations 11 Meets Expectations 12 13 1. Evaluation of billing and collection policies of not-for-profit hospitals related to the uninsured Evaluation of billing and collection policies is insufficient1. Evaluation of billing and collection policies is sufficient2. Evaluation of billing and collection policies is comprehensive3. Below Expectations 0 – 10 Approaches Expectations 11 Meets Expectations 12 13 2. Discussion of ethical issues Discussion of ethical issues is insufficient. Discussion of ethical issues is sufficient. Discussion of ethical issues is comprehensive. Below Expectations 0 – 10 Approaches Expectations 11 Meets Expectations 12 13 3. Decision regarding billing and collection policies of not-for-profit hospitals related to the uninsured Decision regarding billing and collection policies is insufficient. Decision regarding billing and collection policies is sufficient. Decision regarding billing and collection policies is comprehensive. Quality of Writing Below Expectations 0 – 8 Approaches Expectations 9 Meets Expectations 10 11 Lacks professional quality; evidence of disorganized thought processes; major grammatical, spelling and/or typographical errors  Average professional quality; evidence of organized thought processes; relatively few grammatical, spelling, and/or typographical errors Excellent professional quality; evidence of highly organized thought processes; no grammatical, spelling , or typographical, errors Total possible points: 50 Comments 1 The discussion is insufficient in that it lacks specific detail and/or does not address the question. 2 The discussion is sufficient in that it contains minimal detail, but lacks additional contextual information. 3 The discussion is comprehensive in that it is substantive and includes additional contextual information.