Lambert says: Even the smallest modifications to the health care system can result in major improvements.
By Noam Levey, KFF Health News Senior Correspondent. The original article was published in KFF Health News..
ROCHESTER, N.Y. — Jolyn Mangenast spends her days finding ways to help people pay their hospital bills.
Mungenast, who works in a warehouse-like building in a run-down corner of this former industrial city, carefully explains health insurance options, financial aid and payment plans to patients. Mungenast, a financial counselor at Rochester Regional Health, said most people are willing to pay. In many cases that is not possible.
“They’re scared. They’re nervous. They’re upset,” said Mungenast, who worked with an elderly patient on a recent call to settle a $143 bill. “They’re thinking, ‘I don’t want this to affect my credit rating.’ I don’t want them coming to my house.”
At Rochester Regional Health, that doesn’t happen. The nonprofit system in upstate New York is one of the few in the nation that prohibits all active collection activities. Patients who do not pay will not be taken to court. Their wages cannot be garnished. They won’t have a lien placed on their home or be denied care. Also, unpaid bills won’t hurt your credit score.
American hospital officials often argue that lawsuits and other aggressive collections, although unpleasant, are necessary to protect the health system’s finances and discourage freeloading.
But at Rochester Regional Hospital, eliminating these collection tactics hasn’t hurt revenue, said Chief Operating Officer Jennifer Esslinger. The hospital was even able to transfer staff from the collections department because the cost of pursuing unpaid patients decreased.
Esslinger said there is another benefit to this change: rebuilding trust with patients.
“We think about, we talk about, we strategize about where there is mistrust in medicine,” she says. “We need to remove barriers to meaningful care. We need to earn trust with the people we serve so they can get the care they need.”
“People can’t afford this.”
Rochester Regional is a large health system serving a wide range of communities along the southern shore of Lake Ontario, with annual revenues of more than $3 billion.
But in areas where once-powerful employers like Kodak and Xerox have declined, finances can be difficult. In 2022, Rochester Regional finished with a deficit of nearly $200 million.
Each patient has their own challenges. Unable to afford to pay their bills, many faced collections and lawsuits. “We’re going to go to court,” acknowledged Lisa Poworoznek, Rochester Regional’s director of financial counseling.
And before the pandemic, hospital leaders were taking a closer look at why patients weren’t paying their bills.
Poworoznek said barriers such as confusing insurance plans, high deductibles and insufficient savings have been identified. “Patients have different situations,” she said. She added: “It’s not as simple as demanding payment and then filing a lawsuit.”
Nationally, nearly half of adults cannot cover a $500 medical bill without going into debt. 2022 KFF Poll found.At the same time, the average annual deduction for her one worker who receives job-based compensation Currently over $1,500.
Rather than go after people who don’t pay (which is an expensive process that often yields only a small profit), Rochester Regional is getting patients to settle their bills before collection begins. I decided to find a way.
Health systems have begun new efforts to get people into health insurance. New York has one of the most robust safety net systems in the country.
Rochester Regional Municipality has also increased financial assistance programs to make it easier for low-income patients to receive free or discounted care.
At many hospitals, applications for aid are complex, with lengthy applications requiring extensive information about a patient’s income and assets such as cars, retirement accounts and assets, according to KFF Health News. Patients who apply for assistance with Rochester Regional Healthcare are asked to disclose only their income.
Finally, health systems looked for ways to get more people into payment plans so that more people could pay off large bills over one to two years. Importantly, the payment plan is interest-free.
It was a change.Rochester Regional Health, like other major health systems across the country such as Atrium Health, previously rely on a financial company It costs interest and can add thousands of dollars to a patient’s debt.
“The people can’t afford this,” Poworoznek said.
End of “abnormal collection action”
By working more closely with patients on billing, Rochester Regional was able to keep patients out of court.
The health care system also has access to credit, which many health care providers do, which can lower a consumer’s credit score and make it difficult to rent an apartment, take out a car loan, or even get a job. It stopped people from reporting to investigative agencies.
In 2020, Rochester Area Municipality adopted a written policy prohibiting any aggressive collection by the system or its contracted collection agencies.
This makes Rochester Regional a company of choice. 2022 KFF Health News Survey Of the 528 hospitals nationwide that operate billing operations, only 19 hospitals explicitly prohibit so-called abnormal collection practices.
These include major academic medical centers such as UCLA and Stanford University, as well as community hospitals such as El Camino Hospital in California’s Bay Area and St. Anthony Community Hospital outside New York City.
Also, except for unusual collection activities, the University of Vermont Medical Center. Ochsner Health, a large nonprofit organization based in New Orleans. UPMC is a huge system based in Pittsburgh. As in the Rochester area, UPMC officials said they were able to eliminate aggressive collections by developing a better system for patients to pay their bills.
Elizabeth Benjamin, vice president of the nonprofit New York Community Services Association, which has led efforts to limit aggressive hospital collections, said she wants more hospitals to serve their communities, especially those that serve their communities in return. He said there’s no reason hopeful nonprofits should follow suit. Due to tax exempt status.
“The values are about promoting health, caring for the population, and promoting health equity,” Benjamin said. “Suing people for medical debt and participating in extraordinary collection efforts is deeply abhorrent to all of these values,” she said. “Forget about ‘cancer migration’ and children’s immunization clinics.”
The Rochester area approach will not eliminate medical debt. An estimated 100 million people will be burdened In the United States, and the kind of payment plans this system encourages, can still mean big sacrifices for some families.
But Benjamin praised the Rochester area government’s ban on aggressive recalls. “I give them big props,” she said. “It should never have been allowed.”
new york law It currently prohibits all medical expenses from being reported to credit bureaus and limits other collection methods, such as wage garnishment.
Still, many hospital financial leaders say they need the option to go after patients who can pay.
“Maybe the problem is in very specific cases where someone doesn’t pay their bill,” said Richard Gundling, senior vice president of the Healthcare Financial Management Association, an industry group. said.
But Rochester-area financial offices find few patients who simply refuse to pay, officials say. Often the problem is simply that the bill is too high.
“People don’t have $5,000 to pay off that bill,” Poworoznek said.
On phone calls with patients, Mungenast tries to reassure the patient on the other end of the phone. “Put yourself in their shoes,” she said. “How would you feel if you received it?”
About this project
“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR that examines the scale, impact and causes of medical debt in America.
This series uses KFF’s proprietary polling, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a year’s worth of financial aid and collection policies for more than 500 hospitals nationwide. Based on extensive research. .
Additional research Conducted by Urban Research Instituteanalyzed credit bureaus and other demographic data on poverty, race, and health conditions for KFF Health News to find out where medical debt is concentrated in the U.S. and what factors contribute to high debt levels. We investigated whether it is related to
JPMorgan Chase Research Institute Analyzed records We looked at a sample of Chase credit cardholders to find out how customers’ balances are affected by large medical bills. Her CED Project, a Denver nonprofit, also partnered with KFF Health News to survey its clients to find out the link between medical debt and housing instability.
KFF Health News journalists worked with KFF public opinion researchers toKFF Medical Debt Survey” The survey was conducted online and by phone in English and Spanish among a nationally representative sample of 2,375 U.S. adults from February 25 to March 20, 2022. This includes 1,292 adults with current medical insurance debt and 382 adults with medical insurance debt in the United States. For the past 5 years. The margin of sampling error is plus or minus 3 percentage points for the entire sample and 3 percentage points for those with current debt. Results based on subgroups may have a higher margin of sampling error.
Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country. We spoke with doctors, health care industry leaders, consumer advocacy groups, debt lawyers, and researchers. and reviewed numerous studies and surveys on medical debt.
