By Marsha Austin, The Denver Post Knight Ridder/Tribune Business News
Feb. 29--After a year of intense pressure from civil rights advocates, Colorado hospitals have started discounting what they charge uninsured patients for care.
Still, many patients are slipping through the cracks, paying thousands of dollars more than those covered by government or private health programs and battling collection agencies over unpaid bills.
Widespread financial relief may have to wait until hospitals hash out complex legal questions with regulators in Washington, hospital officials say.
Health and Human Services Secretary Tommy Thompson said Feb. 19 that hospitals face no federal penalties for discounting the cost of care for the uninsured. However, executives at Colorado's largest hospital systems said they have no plans to deepen current discounts or extend relief to more of the middle-income uninsured.
'To us it's a confirmation of what we're already doing,' said Jay Picerno, chief executive officer of Centura Health, Colorado's largest hospital system.
On Jan. 1, Centura started giving discounts to uninsured patients with incomes of up to 400 percent of the federal poverty level, or $73,600 for a family of four. Centura also stopped placing liens on patients' homes or garnisheeing wages to collect on debts. HCA-owned HealthOne implemented a similar program last October.
The discount plans don't go far enough, however, said K.B. Forbes, executive director of Los Angeles- based advocacy group Consejo de Latinos Unidos.
Forbes has pressured hospitals in several markets nationwide, including Denver, to give uninsured patients the same discounts given to managed-care plans.
Uninsured patients are charged on average four to five times what hospitals charge health plans and up to 10 times what the federal government pays for the same care, statistics show. That's because hospitals charge those paying out of their pockets the full retail rate, a price that even hospital executives say is not a true reflection of what medical procedures actually cost.
California-based Tenet Healthcare has tentatively agreed to charge all uninsured patients the prices it charges health plans.
But Colorado hospital executives said Thompson's directive did not sweep away all regulatory hurdles to a universal discount plan.
Picerno said Centura fears being sued under federal laws that prohibit hospitals from offering financial incentives to lure patients.
And the federal government's Medicare payments to hospitals are based on their full retail charges. Picerno said two attorneys told him that because of that rule, discounting uninsured patients' bills would drastically reduce the amount of Medicare money Centura would get.
'We're stuck on that legal opinion,' he said.
HHS spokesman Bill Pierce said hospitals can discount care without fear of fines, lawsuits or financial penalties.
'We could not be more clear,' Pierce said. 'Hospitals can give discounts to the uninsured. -- If the hospitals are unable to understand our guidance, they should call.'
Scott Ferguson, a retired artist too young to qualify for Medicare, found out how high a bill can be without a discount after he had a heart attack last December.
Ferguson, 51, was admitted to the hospital with what was thought to be severe pneumonia. A six-day stay at Centura's St. Anthony Central Hospital revealed major heart problems. His care cost $66,900.
Ferguson had dropped his Blue Cross Blue Shield insurance plan the month before because the rates shot up too high, he said.
Ferguson has paid Centura $6,700 and plans to pay another $1,300 -- a total of $8,000, which is more than Medicare would be billed for the same care, according to federal reimbursement guides.
Centura's Picerno said that if Ferguson's annual income falls below $35,920, he will qualify for a discount under Centura's new charity care discount plan, and his bill would be reduced to $36,839. Ferguson is fighting to have his bill discounted.
Ferguson was one of more than 100 Denver-area residents who responded to an advertisement Forbes ran on a Spanish-language radio station recently.
The ad featured a man who said he had paid too much at HealthOne's Medical Center of Aurora.
Thirty-two patients met with Forbes last week to learn how to negotiate price breaks with the hospitals and to tell him about their experiences. Most were Hispanic.
Patients' bills ranged from $1,050 for a visit to the emergency room with a high fever to $55,000 for a broken ankle. In all, their bills total more than $700,000.
Almost everyone had entered through the emergency room. Some spent a few hours there. Others were admitted overnight.
All but two of the patients said they were not offered financial counseling or told about discounts.
'They don't talk about that,' said Dora Velasquez, who owes the Medical Center of Aurora $4,500.
The mother of two went to the emergency room because she was vomiting and dehydrated from the flu on Oct. 3, three days after HealthOne implemented its discount plan for the uninsured.
Her story was echoed by Humberto Patron, who had his appendix removed at Aurora Medical Center. He now owes $22,329 and claims health workers 'never, never told me about discounts.'
HealthOne executives said they work very hard to extend discounts and can't explain why patients aren't getting help.
'We're bending over backwards to help,' HealthOne spokeswoman Linda Kanamine said. 'In many of these cases there is a lack of communication. If we don't hear from them, what kind of business in the world says, 'Oh, OK, you don't have to pay?' '
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(c) 2004, The Denver Post. Distributed by Knight Ridder/Tribune Business News.
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