February 24, 2004

Trying to do the right thing…it's what all of us in healthcare strive for each and every day. It's what we're here for, it's what we live for…making a positive difference in people's lives every hour of every day of every week of every year.

Sometimes, getting to that “right thing” can be tough. It takes hard work. It can cause long nights, headaches, and heartburn. But we know if we keep at it, we'll get to that “right thing” and our hospitals and patients will be the better for it.

Which brings us to the issue of the medically uninsured and underinsured, and helping them with their medical bills. Helping them is the right thing to do; but doing it is certain to get messy until federal overseers and America's hospitals reach total understanding on acceptable policy.

The truth is, things are already messy. Here in Arkansas and all across the nation, lawsuits alleging differences in billing practice for insured patients and those who have no or too little insurance are being filed. Accusations of “overcharging” the uninsured and even “profiting” from them are rampant…remarkable in a time when most hospitals can barely make ends meet and write-offs for charity cases are at an all-time high.

Still, America's hospitals are trying to do the right thing. Seeking payment where possible, and writing off the rest while continuing to offer high quality medical care, always.

America's hospitals must move very carefully when in the realm of charging and billing for services. The federal government has strict rules and regulations that must be followed to a T, or federal funding – upon which hospitals depend – can be lost. The thousands of pages of regulatory documents governing billing practices span a period of many years; hospitals must have clear direction on which regulations remain applicable today and which have, in the government's eyes, been placed by the wayside.

The American Hospital Association has recently distributed guidelines to assist hospitals in helping patients who cannot pay their bills. The guidelines suggest that hospitals provide financial assistance or discounts for patients at or below various percentages of the poverty level, and that bill collection practices be reviewed.

These guidelines signal a strong leap of faith, because until the guidelines are put into practice, it is unknown whether or not the new policies will become ensnared with federal regulations, specifically Medicare and Medicaid provisions. But hospitals are willing to give it a try. In other words, they're trying to do the right thing.

HHS Secretary Tommy Thompson, in a letter to American Hospital Association president Dick Davidson last week, said it is not his intention that hospitals lose federal funding as a result of trying to help uninsured Americans meet their financial obligations. He offered policy summaries for hospitals' use in helping those with no or too little insurance. In other words, he's trying to do the right thing.

For the most part, patients, too, are trying to do the right thing. Most are trying to pay their medical bills, even those who find themselves underinsured or totally without medical insurance. They want to take care of their responsibilities, though many struggle to make ends meet. But they're trying!

So, when you get right down to it, we're all trying to do the right thing…hospitals, government, and patients. And working together, we'll get there. It won't be easy, as we said at the outset, but things WILL work out. And we'll all be the better for it.