Replies to post #140305 on Tornado Alley (PROG)

[PegnVA]

The ER in any hospital is hugely expensive to operate and inner-city ERs are even more expensive to operate. Many hospitals, including where I volunteer, have out-sourced their ER, directly paying only the salary of their employees.
A trend of concern for hospitals is their ERs have become a doctor's visit for those who do not have/cannot afford health insurance. How this growing overload in ERs effects patients is clearly visable - wait times have increased...If you arrive via ambulance, the ER has received a heads-up you're on the way and chances are good you will get pushed to the top of the list.

[F6]

Insurers Told to Justify Rate Increases Over 10 Percent


Kathleen Sebelius, the secretary of health and human services, issued a rule Thursday on procedures for reviews of premiums.
Alex Wong/Getty Images

By ROBERT PEAR
Published: May 19, 2011

WASHINGTON — Alarmed at soaring premiums and profits in the health insurance industry, the Obama administration demanded on Thursday that insurers justify proposed rate increases of more than 10 percent, starting in September.

“Health insurance companies have recently reported some of their highest profits in years and are holding record reserves,” Ms. Sebelius said. “Insurers are seeing lower medical costs as people put off care and treatment in a recovering economy, but many insurance companies continue to raise their rates. Often, these increases come without any explanation or justification.”

Federal health officials proposed the 10 percent threshold in December. The insurance industry criticized it as an arbitrary test that could brand a majority of rate increases as presumptively unreasonable. But the administration rejected the criticism and insisted on the 10 percent standard in the final rule, issued Thursday.

Starting in September 2012, the federal government will set a separate threshold for each state, reflecting trends in insurance and health care costs.

In some states like New Hampshire, groups of more than 20 workers have experienced premium increases of around 20 percent this year, while smaller groups have seen increases of 40 percent or more. At the same time, insurance agents say, coverage is shrinking as deductibles have increased and insurers limit the choice of hospitals.

To ensure that “consumers get value for their dollars,” the new health care law required annual reviews of “unreasonable increases in premiums.”

Under the new rule, federal and state officials will review rates in the individual and small-group insurance markets. In effect, the administration said, large employers can take care of themselves, as they are more sophisticated purchasers and have more leverage in negotiating with insurers.

Federal officials acknowledged that they did not have the authority to block rates that were found to be unjustified. But they said many states had such authority, and the federal government is providing $250 million to states to strengthen their capacity. A small number of states, opposed to the federal health care law, have turned down the money.

The new rule says a rate increase is unreasonable if it is excessive, unjustified or “unfairly discriminatory.” An increase is deemed excessive if it is “unreasonably high in relation to the benefits provided.”

Consumer advocates generally welcomed the rule. “The days of insurance companies running roughshod over consumers and jacking up rates whenever they want are over,” said Ethan S. Rome, executive director of Health Care for America Now [ http://healthcareforamericanow.org/ ], a coalition that includes labor unions and civil rights groups.

Insurers said the rule did nothing to address the underlying costs of health care, which they described as the main factor driving up premiums.

“If we believe health care costs are crushing the economy, we ought to have a debate about how to bring costs under control,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group. “Focusing on premiums diverts attention from that debate.”

In many cases, Ms. Ignagni said, rate increases of more than 10 percent may be justified by rising health costs and the tendency of younger, healthier people to drop coverage, forcing up costs for other policyholders.

States will have the primary responsibility for reviewing rate increases. “But if a state does not have the authority or the resources to conduct a review, our department will step in,” said Ms. Sebelius, a former state insurance commissioner in Kansas.

Under the rule, as part of an effective rate review program, states must have “a mechanism for receiving public comments” on proposed rate increases.

Elizabeth P. Sammis, the acting insurance commissioner in Maryland, said this would be a big change. In many cases, she said, consumers learn of premium increases when they receive notices in the mail, and then they call the commissioner’s office to ask, “Why are rates going up?”

© 2011 The New York Times Company

http://www.nytimes.com/2011/05/20/us/politics/20health.html


===


Health Insurers Lose Push to Ease Rule on U.S. Overhaul Law’s Price Review

By Drew Armstrong - May 19, 2011 1:26 PM CT

U.S. insurers led by WellPoint Inc. (WLP) and UnitedHealth Group Inc. (UNH) failed to get federal regulators to change a rule in the 2010 health-care overhaul that triggers a review of any premium increases exceeding 10 percent.

The ruling takes effect this year and adds pressure on insurers to justify price increases. The health insurance industry’s Washington lobbying group, America’s Health Insurance Plan had asked the government to do away with the 10 percent rate review threshold, calling it flawed.

The rules were prompted partly by a proposal from the California subsidiary of Indianapolis-based WellPoint to raise rates as much as 39 percent in 2010. After a review by California’s insurance commissioner, the underlying calculations were found to be incorrect and WellPoint cut the increase in half, according to the Department of Health and Human Services.

“Effective rate review works,” said Kathleen Sebelius, the U.S. Secretary of Health and Human Services, in a statement announcing the rules. “It does so by protecting consumers from unreasonable rate increases and bringing needed transparency to the marketplace.”

Insurance exchanges set up by the health-care overhaul will offer tax credits for Americans to buy private coverage by 2019. Starting this year, insurers are to provide state and federal regulators with justification for any premium increases of 10 percent or more.

Subject to Reviews
Insurers are subject to the reviews starting on Sept. 1, the government said in announcing the process. In September 2012, the U.S. will set up new price thresholds for state-by- state review to replace the 10 percent benchmark.

Karen Ignagni, the America’s Health Insurance Plan chief executive officer, said policymakers should focus on lowering underlying medical costs such as hospitals, doctors, technology, and drug prices.

“Health plans are doing their part to restrain health-care cost growth by partnering with providers across the country to change payment models to promote and reward safe, high-quality, cost-effective care,” Ignagni said in a statement.

To contact the reporter on this story: Drew Armstrong in Washington at [e-mail];
To contact the editor responsible for this story: Adriel Bettelheim at [e-mail].

©2011 BLOOMBERG L.P.

http://www.bloomberg.com/news/2011-05-19/health-insurers-lose-push-to-ease-rule-on-u-s-overhaul-law-s-price-review.html


===


Health Insurance Rate Hikes Face Tougher Scrutiny

By Julie Appleby
KHN Staff Writer
May 19, 2011

Health insurers seeking rate increases of 10 percent or more will face increased scrutiny starting in September under rules finalized Thursday [ http://www.ofr.gov/OFRUpload/OFRData/2011-12631_PI.pdf ] by the Obama Administration.

States – or in some cases the federal government – will review the flagged premium increases and insurers will have to justify increases deemed unreasonable. The law does not give the federal government power to reject increases, but many state regulators have that authority.

The rules, required by the health care law enacted last year, also require insurers to provide a broad overview of what they plan to spend the money on, including how much would go to medical services, profits and administrative costs [ http://www.kaiserhealthnews.org/~/media/Files/2011/CMS10379Consumer%20Disclosure%20Template.pdf ].

“Recently, insurers have posted some of their highest profits in years … and (yet) they continue to raise rates, often without any explanation or justification,” Health and Human Services Secretary Kathleen Sebelius said in a conference call with reporters. “The framework of the Affordable Care Act is beginning to change this.”

The rules are nearly identical to the proposal issued by HHS in December and come amid continued concern about rapidly rising insurance costs. Such increases have come even as many insurers have seen their costs slow as economically strapped consumers cut back on medical care. Insurers criticized the rules.

“Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” said Karen Ignagni, head of America’s Health Insurance Plans, in a written statement.

“Premium review must adequately factor in all of the components that determine premium rates,” Ignagni added, “including geographic variation, the cost of new benefit mandates, and the impact of younger and healthier people dropping coverage.”

Under the final rule, the 10 percent threshold will be in effect for rate hikes starting Sept. 1 – two months later than originally proposed. But in subsequent years, state-specific thresholds will be developed by the states in conjunction with HHS, reflecting local market conditions.

Consumer groups were generally supportive, with Ethan Rome of the left-leaning Health Care for America Now saying it puts insurers on notice that “unjustified, double-digit premium rate increases will not be tolerated.”

Only insurance policies sold to individuals and small businesses – not those offered to large employers -- are affected by the new rules. Administration officials said they will seek additional comments on whether the rules should be expanded to so-called “association health plans,” which are sold to individuals and small businesses, but are pooled together in large groups.

Timothy Jost, a professor at Washington and Lee University School of Law, said he is disappointed that the rules do not include association health plans.

“That’s a huge loophole and an easy way for health plans to avoid scrutiny,” said Jost.

Some consumer groups also took issue with the 10 percent standard, saying the rule needed a secondary “trigger” – such as increases that go beyond medical cost inflation.

Without such a second option for review, the regulation could “lock in a 9.9 percent increase as the de facto “reasonable” rate,” the advocacy group Consumer Watchdog warned in a letter to HHS.

The group also said the rules allow states to keep private from consumers more in-depth financial details from insurers – information advocates say people need to make their own judgments about rate increases.

“The actual data backing up insurers’ claims will still be private in many states and the public will have no ability to question those assumptions,” said Carmen Balber, director of Consumer Watchdog’s Washington office.

Under the rules, states with “effective” rate review systems will do their own reviews of the increases. To be considered effective, states must show they collect data sufficient to determine whether a rate increase is unreasonable and allow for public comment about the increase.

If a state can’t do an effective review, HHS would do it for them.

The law does not give the federal government the ability to reject increases. That power rests with the states. According to the National Conference of State Legislatures, about two dozen states have laws [ http://www.ncsl.org/default.aspx?tabid=19787 ] allowing regulators to approve or disapprove of some types of insurance premium changes, although how the authority is used varies widely.

In recent months, some state regulators have sought reductions. In Rhode Island, the insurance commissioner lowered a requested 7.9 percent increase to 1.9 percent. After North Dakota policyholders complained, a proposed 24 percent increase was lowered to 14 percent in April.

In the past year, some insurers in California withdrew double-digit increases after regulators found mathematical errors in the companies’ calculations. But another insurer, Anthem, this month moved ahead with increases of up to 16 percent, even after the increase was deemed unreasonable. Regulators there don’t have authority to reject increases, but are seeking legislative authority to do so.

[e-mail]

All original KHN material – articles, graphics and videos – can be used for free, if you credit us and link to us.

http://www.kaiserhealthnews.org/Stories/2011/May/19/insurance-rate-increases-aca-rules.aspx


===


Double-Digit Insurance Rate Increases Get More Scrutiny

By REED ABELSON
May 19, 2011, 2:03 pm

Federal officials announced new rules on Thursday that require health insurers that decide to raise their rates sharply to provide more justification for the higher premiums.

“We know increased scrutiny works,” said Secretary Kathleen Sebelius, of health and human services, in making Thursday’s announcement [ http://www.hhs.gov/news/press/2011pres/05/20110519a.html ]. She cited several recent examples of state regulators, in places like Rhode Island and North Dakota, being able to pressure health insurers to reduce their proposed increases.

The federal health care law requires states to review large rate requests, and the new regulation sets the threshold for review at 10 percent, beginning Sept. 1. Federal officials eventually plan to establish different thresholds for different states. Federal regulators can conduct the reviews if state insurance regulators do not.

The new rule is going into effect as insurers are announcing record profits and flush reserves. In a front-page article [ http://www.nytimes.com/2011/05/14/business/14health.html (first item, two posts back at http://investorshub.advfn.com/boards/read_msg.aspx?message_id=63121962 )] in The Times last week, the sizable gains were linked to how people have been delaying or forgoing care, even as insurers have still been raising premiums. They claim they expect health care costs to go up, once people start to go to the doctor when they feel as if they have more money in their pockets.

“Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” said Karen Ignagni, the chief executive of America’s Health Insurance Plans, a trade group, in a statement responding to the new rule.

She also warned against “an arbitrary threshold for review” that may not adequately take into account the complicated array of factors that determine premium rates.

While the new rule does not give states or the federal government new authority to reject rates before they go into effect, it forces insurers to explain the reasons behind any double-digit increases, according to federal officials. The rule only applies to policies offered to individuals or small businesses because large employers buying coverage for their workers tend to be more sophisticated purchasers, and some states may not have the authority to review premiums for large groups.

Federal officials emphasized that a key aspect of the new rule is the requirement that insurers publicly show their work on the federal government’s Web site and on their own. While some states have the authority to reject rates before they go into effect, the law relies more on increased scrutiny to pressure insurers to keep rates in check.

How effective do you think making insurers publicly justify large rate increases will be in keeping a lid on double-digit premium increases?

© 2011 The New York Times Company

http://prescriptions.blogs.nytimes.com/2011/05/19/double-digit-insurance-rate-increases-get-more-scrutiny/ [no comments yet]

[F6]

Drug Shortages Have Hospitals Scrambling For Alternatives

Written by Christian Nordqvist
Article Date: 30 May 2011 - 9:00 PDT

Hospitals are finding themselves short of a wide range of medications more frequently and for longer. Delaying treatment is becoming less of a rarity at US hospitals today. Emergency doctors fear that soon lives will be lost when they cannot get their hands on some crucial drugs.

There are times when the supply and demand of certain drugs go in wrong directions and there is a shortage, and sometimes total unavailability. What concerns a growing number of health care professionals is that the problem is growing rapidly. 211 drugs were listed as in short supply in 2010, three times more than in 2006.

The University of Utah's Drug Information Service informs that during the first quarter of this year there have been 89 drug shortages. Just on the 25th and 26th of May, 2011, the American Society of Health-System Pharmacists reported new shortages of the following medications - Ciprofloxacin Immediate-Release tablets, Magnesium sulfate injection, Paclitaxel injection, Aminocrapoix acid injection, Prochlorperazine edisylate injection, Triamterene and Hydrochlorothiazide capsules and tablets, and Vasopressin injection.

Hospital pharmacists and medical personnel inform that some shortages can go on for several months. Many of these medications have no ideal substitute. Hospitals in several other countries are reporting similar problems.

In some cases it might be a chemotherapy medication for cancer treatment. Local media in Florida reported a case of a 14-year-old girl with leukemia whose chemotherapy sessions had to be postponed because of a long-lasting nationwide cytarabine shortage.

Pharmacists and drugmakers cite the following reasons for drug shortages:

* Product recalls

* Contaminated vials

* Difficulties in importing certain raw materials

* Demand fluctuations

* Production plants being upgraded (and closed while the upgrade is being carried out)

The more expensive the drug, the less likely there is a shortage of it, experts have noticed. Cheaper, older generic products have smaller profit margins and fewer pharmaceutical companies want to be involved in making them.

Shortages include drugs for a wide range of therapeutic areas, including premature babies, septic shock, intravenous feeding, fertility treatment, ADHD, emergency room cardiac arrest, cystic fibrosis, and cancer.

According to the Institute for Safe Medication Practices, two patients died last year because their substitute painkiller dosage was wrong - at the time there was a shortage of morphine. However, nobody is monitoring patient harm at a national level.

Approximately 40% of thyroid cancer patients will not have access to a drug - Thyrogen - until July or August this year. Thyrogen helps patients who have had their thyroid gland surgically removed avoid the considerable side effects of hormone withdrawal. For those who need this medication, there is no comparable available alternative drug. The European Journal of Endocrinology reports that patients on Thyrogen had 8.1 fewer absent days from work compared to those on withdrawal. Most endocrinologists prescribe Thyrogen before treatment.

Worldwide supplies of Thyrogen will be unreliable until about July, says the Genzyme Corporation, makers of the drug.

Recent shortages of ADHD (attention deficit hyperactive disorder) drugs have sent patients or their parents going from pharmacy-to-pharmacy desperately seeking medications such as Adderall and its generic equivalents. According to IMS Health, the shortage affected a combined 24.2 million prescriptions' worth of drugs in 2010.

Franciscan St. Elizabeth Health Clinical Manager, pharmacist Carol Miller said in a recent interview:

"As a pharmacist working for 20-some years, I've seen shortages, but nothing with the numbers of drugs out there that are short at this time."

Miller believes the recent global economic crisis has affected drug supplies. When the economy is tight pharmaceutical companies tend to drop production of the least money making drugs. If there are generic products available, some drug companies simply stop making their brand products.

With current federal regulations the way they are, it is difficult for generic makers to respond rapidly.

Copyright 2011 Medical News Today (emphasis added)

http://www.medicalnewstoday.com/articles/226896.php


===


Hospitals Hunt Substitutes As Drug Shortages Rise

by The Associated Press
May 30, 2011, 07:41 am ET

WASHINGTON

A growing shortage of medications for a host of illnesses — from cancer to cystic fibrosis to cardiac arrest — has hospitals scrambling for substitutes to avoid patient harm, and sometimes even delaying treatment.

"It's just a matter of time now before we call for a drug that we need to save a patient's life and we find out there isn't any," says Dr. Eric Lavonas of the American College of Emergency Physicians.

The problem of scarce supplies or even completely unavailable medications isn't a new one but it's getting markedly worse. The number listed in short supply has tripled over the past five years, to a record 211 medications last year. While some of those have been resolved, another 89 drug shortages have occurred in the first three months of this year, according to the University of Utah's Drug Information Service. It tracks shortages for the American Society of Health-System Pharmacists.

The vast majority involve injectable medications used mostly by medical centers — in emergency rooms, ICUs and cancer wards. Particular shortages can last for weeks or for many months, and there aren't always good alternatives. Nor is it just a U.S. problem, as other countries report some of the same supply disruptions.

It's frightening for families.

At Miami Children's Hospital, doctors had to postpone for a month the last round of chemotherapy for 14-year-old Caroline Pallidine, because of a months-long nationwide shortage of cytarabine, a drug considered key to curing a type of leukemia.

"There's always a fear, if she's going so long without chemo, is there a chance this cancer's going to come back?" says her mother, Marta Pallidine, who says she'll be nervous until Caroline finishes her final treatments scheduled for this week.

"In this day and age, we really shouldn't be having this kind of problem and putting our children's lives at risk," she adds.

There are lots of causes, from recalls of contaminated vials, to trouble importing raw ingredients, to spikes in demand, to factories that temporarily shut down for quality upgrades.

Some experts pointedly note that pricier brand-name drugs seldom are in short supply. The Food and Drug Administration agrees that the overarching problem is that fewer and fewer manufacturers produce these older, cheaper generic drugs, especially the harder-to-make injectable ones. So if one company has trouble — or decides to quit making a particular drug — there are few others able to ramp up their own production to fill the gap, says Valerie Jensen, who heads FDA's shortage office.

The shortage that's made the most headlines is a sedative used on death row. But on the health-care front, shortages are wide-ranging, including:

—Thiotepa, used with bone marrow transplants.

—A whole list of electrolytes, injectable nutrients crucial for certain premature infants and tube-feeding of the critically ill.

—Norepinephrine injections for septic shock.

—A cystic fibrosis drug named acetylcysteine.

—Injections used in the ER for certain types of cardiac arrest.

—Certain versions of pills for ADHD, attention deficit hyperactivity disorder.

—Some leuprolide hormone injections used in fertility treatment.

No one is tracking patient harm. But last fall, the nonprofit Institute for Safe Medication Practices said it had two reports of people who died from the wrong dose of a substitute painkiller during a morphine shortage.

"Every pharmacist in every hospital across the country is working to make sure those things don't happen, but shortages create the perfect storm for a medication error to happen," says University of Utah pharmacist Erin Fox, who oversees the shortage-tracking program.

What can be done?

The FDA has taken an unusual step, asking some foreign companies to temporarily ship to the U.S. their own versions of some scarce drugs that aren't normally sold here. That eased shortages of propofol, a key anesthesia drug, and the transplant drug thiotepa.

Affected companies say they're working hard to eliminate backlogs. For instance, Hospira Inc., the largest maker of those injectable drugs, says it is increasing production capacity and working with FDA "to address shortage situations as quickly as possible and to help prevent recurrence."

But the Generic Pharmaceutical Association says some shortages are beyond industry control, such as FDA inspections or stockpiling that can exacerbate a shortage.

"Drug shortages of any kind are a complex problem that require broad-based solutions from all stakeholders," adds the Pharmaceutical Research and Manufacturers of America, a fellow trade group.

Lawmakers are getting involved. Sen. Herb Kohl, D-Wis., is urging the Federal Trade Commission to consider if any pending drug-company mergers would create or exacerbate shortages.

Also, pending legislation would require manufacturers to give FDA advance notice of problems such as manufacturing delays that might trigger a shortage. The FDA cannot force a company to make a drug, but was able to prevent 38 close calls from turning into shortages last year by speeding approval of manufacturing changes or urging competing companies to get ready to meet a shortfall.

"No patient's life should have to be at risk when there is a drug somewhere" that could be used, says Sen. Amy Klobuchar, D-Minn., who introduced the bill.

EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Copyright 2011 The Associated Press (emphasis added)

http://www.npr.org/templates/story/story.php?storyId=136788289 [no comments yet]

[F6]

Hospitals Flout Charity Aid Law


Myrlene Stimphil and her son, McKenny Francois. She said NYU Langone Medical Center never answered their request for aid.
Suzanne DeChillo/The New York Times


Christopher Ward lives at his father's house and gets by on a disability check.
Suzanne DeChillo/The New York Times


One of Christopher Ward's bills from NewYork-Presbyterian Hospital, which seized his bank accounts.
Suzanne DeChillo/The New York Times


Hope Rubel, an unemployed graphic designer, was sued by NewYork-Presbyterian Hospital after receiving $88,000 in bills. She settled after failing to get the hospital's financial aid department to accept her documentation.
Suzanne DeChillo/The New York Times

By NINA BERNSTEIN
Published: February 12, 2012

For most of her life, Hope Rubel was a healthy woman with good medical insurance, an unblemished credit history and a solid career in graphic design. But on the day an ambulance rushed her to a Manhattan hospital emergency room shortly after her 48th birthday, she was jobless, uninsured and having a stroke.

Ms. Rubel’s medical problem was rare, a result of a benign tumor on her adrenal gland, but the financial consequences were not unusual. She depleted her savings to pay $17,000 for surgery to remove the tumor, and then watched, “emotionally paralyzed,” she said, as $88,000 in additional hospital bills poured in. Eventually the hospital sued her for the money.

Yet that year the hospital, NewYork-Presbyterian [ http://nyp.org/ ]/Weill Cornell, had already collected $50.2 million from the state’s so-called Indigent Care Pool to help care for people like Ms. Rubel who have no insurance and cannot pay their bills.

New York’s charity care system, partly financed by an 8.95 percent surcharge on hospital bills, is one of the most complicated in the nation, but many states have wrestled with aggressive debt collection [ http://www.familiesusa.org/assets/pdfs/medical-debt.PDF ] by hospitals in recent years. Like New York, several passed laws curbing hospitals’ pursuit of unpaid bills, including Illinois, California and Minnesota.

But a new study of New York hospitals’ practices and state records [ http://www.cssny.org/userimages/downloads/IncentivizingPatientFinancialAssistanceFeb2012.pdf ] finds that most medical centers are violating the rules without consequences, even as the state government ignores glaring problems in the hospitals’ own reports.

“The entire system is corrupted, and it isn’t working for patients,” said Elisabeth R. Benjamin, vice president of health initiatives at the Community Service Society [ http://www.cssny.org/ ] of New York, a nonprofit antipoverty group, which is releasing the two-year study on Monday.

The state’s Department of Health acknowledges systemic problems, including the need for better reporting and enforcement, a spokesman, Michael Moran, said. A group of patient advocates and hospital administrators is being convened to develop a better system, he said, and the department is engaged in “a comprehensive data integrity project that will include the retention of an outside auditor.”

The study found that some hospitals did not provide financial aid applications at all, and that many made impermissible demands for irrelevant documents or failed to supply key information, like eligibility rules for big discounts required by state law in 2007. Data reported to the state was obviously faulty, it found.

Yet even hospitals that reported they had spent nothing on financial aid, or had filed hundreds of liens against patients’ homes, were allowed to collect without questions from the charity care pool, which distributes more than $1 billion a year.

Hospitals are not legally barred from seeking judgments or liens, but must first offer an aid application, help the patient complete it, and wait while it is pending. Instead, many hospitals turn to collection agencies, and sue when that fails. The unpaid bills — typically reflecting much higher rates than what insurers pay — are then treated as the equivalent of charity care.

Change is now urgent, health care experts agree [ http://www.cphsnyc.org/cphs/what/charitycare/ ], because the state pool stands to lose hundreds of millions of federal dollars in 2014, when provisions of the health care overhaul will no longer treat so-called bad debt, based on uncollected bills, as if it were charity care.

“There’s a law in place, and obviously it should be complied with,” said David Rich, an executive with the Greater New York Hospital Association [ http://www.gnyha.org/1/Default.aspx ], a trade group. But, he added, “hospitals are providing a lot of charity care at a loss.”

He said hospitals were improving their compliance with the law, which requires aid to patients with income up to 300 percent of the poverty line, or up to $33,000 for a single person. But, often stymied by patients who fail to complete applications for aid, he said, many hospitals have moved to simply deeming some patients eligible without an application, using what he called “a soft credit check” at registration to gauge income and assets.

Myrna Manners, a spokeswoman for NewYork-Presbyterian Hospital, said that it would be inappropriate to discuss specific cases, but that the hospital “proactively helps patients at every step” of the financial aid process. It approved 25,861 applications in 2010, the most recent annual data.

“Where there has been a determination that there is an ability to pay, we still go to all lengths to ensure that we resolve the matter before it becomes a legal action,” she said.

Court records abound in judgments against patients who say they had little or no chance to apply for help. A couple fighting foreclosure in Elmont, Nassau County, has a $41,000 default judgment from NYU Langone Medical Center [ http://www.med.nyu.edu/ ] for emergency surgery on their disabled adult son in 2007, when their insurance unexpectedly dropped him. He was eventually approved for Medicaid, but it would not pay for the surgery retroactively.

The mother, Myrlene Stimphil, 55, a nurse at a city hospital, said she had sought a reduced payment plan from NYU Langone, but was told only that the hospital would get back to her. Instead, she said, collectors were calling her son, now 24, who suffered brain damage at his premature birth.

“We don’t want to be a burden,” she said, as her husband, Antenor Francois, 56, a former cabdriver, looked through old bills. One announced, “Welcome to Portfolio Recovery Associates!” and added that the collection agency “purchased your account from NYU Hospitals Center.”

Lisa Greiner, a spokeswoman for the hospital, which collected $10.7 million from the charity care pool in 2010, said she could not comment on the case under privacy laws. But the hospital no longer uses that collection agency, and under new leadership in the last three years, its reported financial aid approvals soared to 36,000 in 2010, from 256 in 2008.

Christopher Ward, 49, living in his father’s house in White Plains on a $200-a-week disability payment from a workplace spinal injury, recalled stopping at an A.T.M. — “just to have something in my pocket to buy food” — and discovering that his accounts, totaling less than $4,000, had been seized.

“I tore my hair out for a long time not understanding why all this was happening to me,” Mr. Ward said, admitting to memory lapses.

Court records show that NewYork-Presbyterian obtained a $102,636 judgment against him in 2007, including 9 percent interest back to 2004, when, uninsured, he underwent emergency surgery for a brain aneurysm. Now his ailing, widowed father, 75, a teacher at Mercy College, worries that anything he leaves for Christopher could be seized.

State hospitals seem to be especially aggressive collectors. State University of New York Downstate Medical Center [ http://www.downstate.edu/ ], in Brooklyn, secures hundreds of judgments annually through the attorney general’s office, which says such suits protect the state’s interest in case a former patient comes into money.

One picked at random: a $12,000 judgment in 2008 against Cherrilyn McFarlane, a single mother on public assistance, for one day’s care for her newborn five years ago, when her Medicaid coverage had briefly lapsed. Ms. McFarlane said the judgment could hurt her plans to seek a student loan for nursing school. “I want to get it cleared,” she said.

To Hope Rubel, the greatest fear was that the suit itself would deter employers from hiring her and leave her destitute, she wrote the judge. Finally, she said, a law clerk directed her to the hospital’s financial aid department. It said more documents were needed to decide her eligibility.

“I had given them everything,” she said. In despair after a year of courthouse meetings, she said, she offered $100 a month, and at the court’s urging, the hospital’s lawyers accepted. “I’ll be paying for the rest of my life,” she said.

© 2012 The New York Times Company (emphasis added)

http://www.nytimes.com/2012/02/13/nyregion/study-finds-new-york-hospitals-flout-charity-rules.html [ http://www.nytimes.com/2012/02/13/nyregion/study-finds-new-york-hospitals-flout-charity-rules.html?pagewanted=all ] [with comments]