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NJ group suggests billing, collections guidelines
The New Jersey Hospital Association has unveiled billing and collections guidelines designed to help hospitals respond to the needs of low-income, uninsured patients.
The move follows various actions by hospitals across the nation and some state legislatures to bring clarity to policies and procedures regarding those who are struggling to pay their hospital bills. Attention was focused on the subject as the result of a February 2004 statement from the Bush administration encouraging hospitals to give discounts to uninsured patients and financially needy Medicare beneficiaries.
The New Jersey guidelines were developed by a task force of hospital executives in response to the state’s growing number of uninsured, which is now 1.2 million. Among other things, the guidelines say hospital financial aid policies should be consistent with the mission and values of the hospital and take into account each patient’s ability to contribute to the cost of his or her care.
The guidelines also say hospitals should work with patients when necessary and appropriate to create a reasonable payment plan.
The American Hospital Association in Chicago has encouraged hospitals to review their billing and collections guidelines, and issued a set of recommended practices in December 2003. New Jersey is one of the first states to issue state-level guidelines. To read the guidelines, go to www.njha.com
ED problems highlighted: Cost, capacity issues cited
An estimated 2.8 million adults who sought care in hospital emergency departments (ED) in 2001 reported delays or access problems, according to a study recently published in the Annals of Emergency Medicine.
That is about 7.7% of the estimated 36.6 million adults who sought care in a hospital ED that year.
Waiting time was the most frequently noted access problem, but concerns about health insurance coverage and the cost of emergency medical services were also commonly cited. Access problems were more likely to be reported by patients who were young, poor, and uninsured, and those in worse health were disproportionately at risk, the study found.
Study reveals capacity challenges
Meanwhile, a recent survey by the Chicago-based American Hospital Association highlighted hospitals’ varying ED capacity challenges.
Inpatient occupancy rates captured at midnight fail to reflect volume fluctuations by day and time of day, the study found, illustrating the difficulty of anticipating and responding to changes in demand. According to the study, those changes can be extreme.
The case studies done by the Lewin Group follow up on a 2002 national survey by Lewin that revealed that nearly 80% of urban hospital EDs are at or over capacity, with more than half reporting diversions.
The latest survey looked in depth at 28 hospitals in four communities — Louisville, KY; Portland, OR; Harrisburg, PA; and El Paso, TX — to see when and where capacity constraints occur within the hospital and how diversion situations develop across a community. The study found capacity constraints and ambulance diversions continue to be concerns in these communities, with more than half the hospitals in each community reporting their EDs at or over capacity.
Though all of the communities experienced some level of ambulance diversion, diversion hours varied by community, as did the factors driving the diversions and hospital capacity constraints. Even within a hospital, the specific capacity issue leading to diversion differed across the three days studies.
Summaries of both the 2004 and 2002 survey results can be found at www.aha.org
Final stretch proves tough in HIPAA privacy effort
Health care providers are getting close to being in full compliance with the Health Insurance Portability and Accountability Act’s (HIPAA) privacy requirements, which became effective in April 2003. However, getting to the finish line is proving difficult, according to a survey conducted by the American Health Information Management Association.
The survey of nearly 1,200 health care privacy professionals on their organizations’ level of compliance with the HIPAA privacy standard was reported in a recent issue of Modern Healthcare.
About 68% of the 1,192 HIPAA-compliance professionals surveyed (more than half worked in hospitals), said their facilities were between 85% and 99% compliant with the rule, while 23% said their organization was fully compliant.
However, some 39% of respondents said accounting for the release of protected health information was an ongoing problem area, and 33% said obtaining protected health information from other providers was another compliance trouble spot.
In another development regarding the privacy standard, the American Hospital Association (AHA) recommended additional changes to eliminate problems with the rules that interfere with essential hospital operations.
AHA president Dick Davidson urged the Department of Health and Human Services (HHS) to adopt solutions to eliminate the paperwork and other burdens associated with accounting of disclosures and business associate requirements.
For example, the rule now imposes what Davidson says is an unnecessary paperwork burden on hospitals to account for numerous and frequent disclosures of information that they must make to public health authorities, regardless of whether any patient ever requests such an accounting of disclosures. The rule also requires business associate agreements between health care entities that are already covered by the rule.
AHA also encouraged HHS to share information obtained from efforts to monitor compliance to help hospitals understand best practices.
Almost half of U.S. adults lack health literacy
Almost 90 million Americans, or half of the adult population, do not have the ability to understand and make informed decisions about their health. This situation may cause billions of dollars in avoidable health care costs and higher hospitalization rates and use of emergency services, according to a report recently released by the Institute of Medicine.
The report, which can be found at www.iom.edu, recommends that health care systems, educators, employers, and community organizations develop programs to improve health literacy — the degree to which individuals obtain, process, and understand basic information and services needed to make appropriate health decisions.
For example, the report says patients need health literacy to discuss care with health professionals and to understand patient information sheets, consent forms, and advertising.
State cutbacks affect health coverage for low-income families
Health care services for low-income families continue to face cutbacks as state budgets are adopted for fiscal year 2005, according to a new report by the Center on Budget and Policy Priorities. Georgia, Florida, California, Missouri, and New York are among the states that have adopted or are considering limiting eligibility for health insurance programs for low-income families in their fiscal year 2005 budgets. For example, the Georgia state legislature has just approved a budget that reduces Medicaid eligibility levels for almost 20,000 pregnant women and infants. And the Missouri legislature is considering a reduction that would heavily cut Medicaid, thus ending coverage for about 65,000 low-income people, including 41,000 low-income parents and 21,000 children.
Thirty-four have adopted cuts, which will result in 1.2 to 1.6 million low-income people to lose health insurance. Children and parents in families in which the parents work at low-wage jobs are expected to be the most harshly affected. For instance, Texas will end coverage under the Children’s Health Insurance Program for nearly 160,000 children in working families, and Connecticut reduced Medicaid eligibility for parents with incomes from 100%-150% of poverty, with about 20,500 parents affected. Six states — Alabama, Colorado, Florida, Maryland, Montana, and Utah — have stopped enrolling eligible children in their State Children’s Health Insurance Program. In addition, new or higher copayments for public health insurance services were imposed by 21 states for fiscal year 2004.
Research has shown that copayments are a significant deterrent to the use of essential medical care and prescription drugs among low-income populations, and that there are adverse health consequences when such treatment is foregone or delayed. The report can be found at www.cbpp.org/4-22-04sfp.htm