Indigent Care or Wallet Biopsy?

The AHA adopts principles, develops guidelines

The American Hospital Association (AHA) has adopted principles and guidelines on billing that confirm the commitment of America’s hospitals to serve their communities with compassion and professionalism. The principles approved by the AHA board of trustees include:

  • treating all patients equitably, with dignity, with respect, and with compassion;
  • serving the emergency health care needs of everyone, regardless of a patient’s ability to pay for care;
  • assisting patients who cannot pay for part or all of the care they receive;
  • balancing financial assistance for some patients with broader fiscal responsibilities to keep hospitals’ doors open for all who may need care in a community.

The AHA board contends hospitals’ work is made more difficult by the nation’s fragmented health care system — a system, it says, that leaves millions of people unable to afford the health care services they need; a system in which federal and state governments and some private insurers do not meet their responsibilities to cover the costs of caring for Medicare, Medicaid, or privately insured patients; a system in which payments do not recognize the nonreimbursed services provided by hospitals; a system in which a complex web of regulations prevents hospitals from doing even more to make care affordable for their patients.

In the guidelines, AHA is striving to get 5,000 member hospitals to agree to cover helping patients with payment for hospital care, making care more affordable for patients with limited means, and ensuring fair billing and collection practices.

In testimony before the House Ways and Means Subcommittee on Oversight, AHA board chairman David Bernd, CEO of Virginia’s Sentara Health Care, said that as AHA developed its principles and guidelines, "it became clear that hospitals were concerned about violating federal regulations governing billing and collections that had accumulated over many years. This became an impediment to hospitals’ efforts to assist patients of limited means with their hospital bills.

"The rules are numerous, often confusing, and, as even the administration acknowledged, scattered among many different official publications. The AHA sought to address that issue and asked the administration to bring new clarity to the rules to assist hospitals in their efforts to improve their charity care and other payment policies for patients of limited means."

Mr. Bernd credited Health and Human Services Secretary Tommy Thompson for a guidance addressing many of the concerns AHA raised on behalf of the field.

Because of that guidance and a forum at which hospital representatives were able to ask specific questions, he said, hospitals are moving ahead to improve their charity care and financial assistance policies and practices and make them available to even more patients of limited means.