Posted on 12/06/2006 7:35:54 AM PST by rontun
LACONIA -- The rising costs of delivering healthcare combined with the transformation taking place in the structure of employee benefit programs are driving changes in the way LRGHealthcare bills for the services provided by Franklin Regional and Lakes Region General Hospital, the Laconia Clinic, and other providers affiliated with the local, non-profit charitable trust.
“We’re seeing a continuing evolution in the programs we offer to assist people with the costs of care,” said Henry Lipman, LRGHealthcare Vice President and Chief Financial Officer. “What’s important is that people have access to the care they need, and that they’re treated fairly when it comes to billing.”
Like other hospitals and healthcare providers throughout the country, LRGHealthcare has frequently been criticized for charging different patients different fees for the same services. Discounts offered to Medicare and Medicaid patients, for instance, and to those covered by insurance companies which have negotiated fee reductions, have not always been extended to the uninsured.
“We’ve been out in front changing that,” Lipman said yesterday. “We’re leveling the playing field.”
It was in 2001 that LRGHealthcare first introduced its Patient Advantage program, which awarded discounts of 20 percent for uninsured patients who prepaid or paid within 48 hours of the time the service or treatment was performed. Those unable to pay within that timeframe have been extended a 10 percent discount if the amount is paid within 20 days of the time of billing.
For many, however, who did not have the financial ability to prepay or to settle their accounts within the set time frames, the discounts had little value. “We were aware that many were unable financially to take advantage of the program, and we’ve worked continuously to refine our policies,” Lipman said.
Added this past year has been the Patient Advantage Plus program, which offers an automatic 15 percent discount to all self-pay patients, defined as those without insurance. In addition, the Patient Advantage program has been broadened to include an 8 percent discount for those who make arrangements to pay their bills over time.
None of these discount programs require that any detailed financial statements be provided.
The HealthLink Catastrophic program goes even further. For patients who have incurred costs in excess of $10,000, a reduction of 30 percent is offered. This benefit does require the completion of a financial statement and is based upon income and assets.
But even the income and asset tests have undergone changes. “We used to exempt $100,000 in home equity,” Lipman noted. “We’ve increased that to $150,000.” Even with the various discount programs, LRGHealthcare was forced to absorb over $13 million in bad debt last year from fees it was unable to collect for services and treatments provided. Moreover, it spent in excess of $7.5 million for charitable care.
“Our first concern is making sure people receive the care they need,” Lipman said. “We don’t want anyone to be denied healthcare because of their inability to pay.”
Nevertheless, Lipman acknowledges that collecting for services is vital to maintaining LRGHealthcare’s ability to fulfill its mission. “We have a responsibility to our patients and to the community to make sure we can survive financially,” he explained. “We do pursue good business practices.”
Those practices include making certain that those who have the ability to pay for services meet their obligations. “It wouldn’t be fair to those who do pay to allow others who can pay to avoid their responsibility,” he said.
Last year LRGHealthcare served over 137,000 patients through the hospitals, the Laconia Clinic, and other affiliated providers. Of those, fewer than 8 percent had their bills sent to collections for non-payment. And of those, Lipman said 99.92 percent of the cases were resolved.
“We average about 110 lawsuits per year,” Lipman said. “That’s a very small portion, and we only go to court as a last resort.”
Margaret Sullivan, an attorney to whom collection matters are referred when LRGHealthcare has been unsuccessful in its attempts to collect on past due bills, confirms Lipman’s account. “Most cases are referred to me because patients have been unresponsive,” she explained. “More often than not, a letter from me will get a response.”
According to Sullivan, in many instances people are unresponsive simply because they’re embarrassed at being unable to pay, or they’re confused about their options or what to do. “Usually, something can be worked out,” she said. “Either they make arrangements to pay, or they learn that they qualify for assistance that they didn’t know was available.”
To assist patients with financial matters LRGHealthcare employs over a dozen people, including Sharon Lemire, Director of Patient Financial Services, Linda Glassett, Customer Service Coordinator, and Maureen Record, Enrollment Coordinator.
Each is focused on finding solutions to fit the needs of patients. “We don’t have anyone whose job is collections,” Lemire said. “What we have are customer service representatives.”
Those representatives help to steer patients to the various programs available to assist with costs. “We understand that people have a lot of issues to deal with,” Lemire said. “We don’t want to add to their burden.”
For patients looking for financial assistance, LRGHealthcare’s website at www.lrgh.org has posted a description of the various programs available. For those without access to the Internet, a telephone call to Lemire, Glassett or Record is the place to begin.
“We don’t want people to be afraid,” Lipman reiterated. “We’re here to provide the care they need.”
“You know, in the ten years I’ve been representing LRGHealthcare, we’ve never moved on an involuntary lien on someone’s property,” Sullivan offered as reassurance. “We’ve never foreclosed on anyone.”
Nobody mentions the fact that the reason healthcare and college tuition go up is because they know they'll get the money no matter what thanks to insurance and financial aid. Therefore there are no market forces at work keeping prices down.
Do you have a link for this?
Welcome to FR. I note that your paper doesn't seem to post the articles at the website. You might want to make a note of that when you post. If I missed the online site with the internet version, please point me in the right direction. (I am assuming you are Ron Tunning, News Editor.)
$39 a visit and no appointment needed. Saw a doctor, got to talk to him for a solid 15 minutes along with a kidney function blood test. It was $68 cash out the door. Got a couple of generic prescriptions - antibiotic and cortico-steriod cream (aka. "the clear") for about $15.
Infection cleared up and no bill coming in the mail.
Great experience.
You're correct and I should note that our daily newspaper does not post its articles on its webpage, not because we wouldn't like the added exposure, but because we've yet to have invested the resources in developing and maintaining a website.
That may sound foolish in today's world, but our focus has been on capturing market share from our competitor, The Citizen -- an afternoon daily for over 80 years which this month switched to morning publication. It's taken us six years to build a daily circulation of 12,000, a formidable accomplishment in what is the only New England market outside Boston to sport two daily newspapers.
The success of our approach of concentrating on the print product is demonstrated by steady circulation growth, with the Daily Sun's circulation having grown from zero to 12,000 in six years, while The Citizen's circulation has been in steady decline, falling to fewer than 9,000 daily copies.
Good question, but I don't think such an outcome will result. The uninsured are not receiving the same benefit coverage as those insured, but are merely being charged similar fees for services.
The benefit to being insured is having the costs of services paid for by the insurer -- be it Medicare, Medicaid or private insurers. The uninsured, to the extent of their ability to pay, remain personally obligated for the costs.
Good luck. Maybe the sidebar moderators can let you know on how and where to post your articles, if they haven't already.
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