New York Hospitals Give Uninsured a Break
This month in New York after decades of overcharging the uninsured, hospitals in New York were among the first in the country to cut charges for uninsured patients. The hospital industry's use of ruthless collection tactics and its practice of billing America's 43.6 million uninsured at inflated retail rates has been the focus of many recent articles in the Wall Street Journal.

When I started working at Rose Medical Center in Denver over 10 years ago, I was able to provide care for some uninsured patients. The hospital accepted these patients without charging a dime. After the hospital was converted to a "for-profit" hospital by Columbia-HCA, my ability to provide care at Rose for the uninsured evaporated.
In my last year there I had to tell many uninsured that I would perform surgery at Medicaid rates BUT Rose Medical would not accept these rates. The hospital billing department told my patients that the charges were many times even what an excellent managed care company would pay. For example one patient needed a colon resection and was told the hospital bill would be $40,000 - 1/2 was due immediately and a quarter over the next two months. Minor surgery patients were told they would owe Rose Medical $4,000 and up. Since none of these uninsured patients had this money, they had to go elsewhere for their surgery. I pleaded with Rose Medical to reduce their charges to Medicaid level, but the hospital refused. This I felt was clearly unethical.

The Denver Post cited in 2002 that not all Denver hospitals were sharing the burden of caring for the uninsured equally. Most of these patients had to go to Denver General or the University hospital. The Columbia-HCA "for-profit" hospitals such as Rose Medical and others each made a profit. I wonder why? If you are not sharing in the burden of providing for the uninsured, you are likely seeing paying patients. Interestingly these hospitals provided a tiny amount of the uninsured care.  ¶ 8:39 AM

  On November 1, 2002 it was reported that Colorado’s urban hospitals dramatically increased profit margins with HealthOne (an HCA company) reporting a 55 percent increase from 2000 to 2001. One wonders how much of this hospital system’s profit is at the expense of not providing free care for the uninsured. About 14% of Denver’s population has no insurance yet HCA/HealthOne provides a miniscule amount of charity care compared to other hospital systems. As a provider for the last 10 years in Denver I saw hospitals provide less and less charitable care for the uninsured. Several patients without insurance came to me for surgery last year. These patients were referred to Rose Medical Center (an HCA facility) to ask about free care and all were told that the care would not be free. They were told they had to pay full rates over 3 installments. One patient was asked to make a $20,000 deposit and pay the remaining balance of several thousand dollars over the next 2 months. I performed colonoscopy on my cousin who had no insurance for free but Rose Medical sent him to collections for over $2,500. Since hospitals are getting less from insurers and HMOs, the uninsured are being asked to pay full charges and often aggressive collection tactics are used. In June the House Committee on Energy and Commerce initiated preliminary investigation into this kind of hospital billing and debt-collection practice.

High hospital markups also contribute to hospital profits but this drives up health care costs. HCA/Rose Medical Center is among the 100 U.S. hospitals with the highest markups in their gross charges over costs. This list is published on www.calnurse.org. Rose is number 61 on the list with a markup of 583% over actual costs. For each $1,000 it costs to provide your care, Rose charges an extra $5,830. For-profit hospital systems such as Tenet and HCA dominate this list. Tenet is under investigation and HCA just settled the largest health care fraud case in U.S. history for $1.7 billion.

No wonder hospital profits are soaring. So are our health care costs. These kinds of hospital billing and pricing practices, especially by for-profit hospitals, call for greater public scrutiny and government oversight.
  ¶ 7:51 PM