Patient Satisfaction Planner

WA hospitals adjust to meet aid guidelines

Change 'not that big' for some

At Yakima Valley Memorial Hospital in Washington the implementation of new state-wide financial assistance guidelines "wasn't really that big of a change," says John Vornbrock, FACHE, senior vice president and CFO.

With the focus in the past couple of years on nonprofit hospitals promoting community benefits, including charity care, he adds, "we had been emphasizing that and trying to make charity care applications much more accessible to the public."

The goal at Memorial Hospital is that any patient who is registered for a service but for whom no insurance has been identified is provided with a charity care application, Vornbrock says.

That effort, begun in early 2006, has increased the volume of financial aid applications so much that it has been necessary to add a new staff position, he notes. "We actually have an individual whose full-time job is to go through those applications and ask additional questions to determine [whether patients] meet the criteria."

Despite the additional volume, the overall amount of uncompensated care at the hospital has not increased, but has gone down a bit, Vornbrock says. "The difference has been that a higher percentage of uncompensated care is charity care as opposed to bad debt that goes to collections."

When the state program came along, he adds, "we tweaked our guidelines to go along with that. The bottom line is that we previously had not offered any charity care [to patients] above 200% of the federal poverty level, but now those between 200% and 300% are included."

While the effect of that category change has not been determined, Vornbrock says, he doesn't expect that difference to be a significant amount.

About two-and-a-half years ago, he notes, Memorial instituted a policy whereby any individuals without insurance were automatically given a 25% discount on hospital charges

"That came at a time when there was a lot of criticism of hospitals that only the uninsured were paying full charges, and then clarification from Medicare [on what constituted] fraud and abuse," Vornbrock says. "It was the first time hospitals ever considered doing anything other than full charges. We had always been told we couldn't do that, that it was a violation."

Implementing the 25% discount "also had a big impact on changing the composition of uncompensated care," he adds, "so [the state program] has not really resulted in more charges being written off. This is a really poor community to begin with."

When the national discussion on charity care heated up, it was not as big a deal in Washington because of the state's existing statute on charity care, Vornbrock points out.

"[Hospitals] had to comply," he notes. "Some hospitals have actually bumped up their limits. Quite a few are at 400% of the federal poverty level."

When the new financial assistance guidelines were implemented at Grays Harbor Community Hospital in Aberdeen, WA, in early 2007, it meant a dramatic increase in the number of people who are eligible to receive aid, says Jacquie Shay, director of patient financial services.

"There's a real satisfaction in the business office because a lot more people in higher income levels qualify," add Shay, who oversees the business office, registration, and medical records. "There's more paperwork, more phone calls, more people asking for assistance as more people become aware that they may qualify. It's very gratifying that we can help them."

Her department hasn't yet increased staffing, but is "feeling burdened," she says. "It's only been a couple of weeks, but it's quite noticeable. It takes a little longer on our end to figure out [who qualifies]. There is a learning curve to learn how to do the task differently."

For her hospital, the new guidelines open up the possibility of financial aid to one category of patients while placing tighter restrictions on another, she explains.

"Up until January, we were providing a 100% write-off [of charges] to people at or below 200% of the federal poverty level," Shay says. "Not everyone was doing 200%, but we were being generous."

That means that before a one-person "family" making $19,000 might have had its entire hospital bill written off, but under the new guidelines would get only 58% written off, she explains.

"Now we are spreading [the help] out, giving it to people who are at up to 300% of the federal poverty level," Shay adds. "A lot of people make a decent wage, but there is not enough money to go around. Now at least they can get a percentage of the bill written off.

"The general consensus is that we support [the new guidelines]," she says. "We are pleased to offer help to those we couldn't help before."

[Editor's note: John Vornbrock can be reached at (509) 575-8003. Jacquie Shay can be reached at]