California healthcare - and closer to home
Gov. Arnold Schwarzenegger has proposed some sweeping changes that he says are intended to ensure that Californians have access to the health care we deliver every day.
Some of the suggestions proposed during the governor’s State of the State Speech in January have triggered a furor among many of our colleagues. Clearly, the governor didn’t reference the specific policies that Stanford has adopted to help patients secure access, but some of the things we are doing resonate clearly with what the governor says and deserve our active attention. I’ll say more about these local policies in a minute. But first, let’s look at the statewide agenda.
In his Health Care Proposal for California, the governor reminded us of our rights and obligations as physicians and then went on to talk about the challenges of patient access. He said the system is broken, because:
A large segment of the population is uninsured.
Many of the uninsured are employed but have no employee healthcare option. (Sorry, folks, more jobs are not the solution).
Californians with health insurance confront a “hidden tax” because they pay higher insurance premiums and medical costs to subsidize the healthcare of their fellow citizens who lack coverage.
Emergency departments are closing across the state for various reasons, including their high costs of operation.
Health costs are rising because of such dysfunctional phenomena as preventable chronic diseases, medical errors, and the overhead costs of caring for the uninsured.
Schwarzenegger outlined a broad initiative to reduce the hidden tax, lower costs, support better care, and work toward a healthy California.
The proposal, still in outline form to be configured by the legislature, includes:
Improved prevention programs for obesity, smoking prevention and diabetes to bring down the costs of preventable chronic illness. He suggested possible incentives for consumers to adopt healthy activities and practices.
Recommendations to reduce medical errors by adopting e-prescribing for all outpatient medicine in the state.
A call to strengthen patient safety and accountability.
And, last but not least, is the point which has hit the hot button for many physicians and hospital administrators: the governor hopes to make insurance affordable for all through what he calls “shared responsibility.”
Schwarzenegger proposed a tax of 2 percent of all physicians’ revenues and 4 percent of all hospital revenues to help fund an expanded Medi-Cal program. It’s based on a complex formula of income but would be weighted toward trying to make sure that all California children are covered. The proposal would cover all children in families earning less than 300 percent of the federal poverty level (about $60,000 yearly depending on family size) and would add more adults below the poverty line. Subsidies would enable low income families to participate in an insurance purchasing pool. The “carrot” for hospitals and physicians is a $4 billion increase in Medi-Cal reimbursement rates.
We all want more health care access, especially for children. However, the devil is in the details, notably, how will the governor’s proposal be funded fairly?
Many physicians have reacted by putting up the barricades. But not so fast.
A week after the governor’s speech, I traveled to the state capital to attend the annual meeting of the California Association of Neurosurgeons (CANS), my specialty society concerned with the socioeconomic happenings for neurosurgeons practicing in our state.
Representatives from the California Medical Association spoke at our CANS meeting and suggested that we as physicians should not overreact to the darker side of the governor’s proposal. The CMA believes that Schwarzenegger’s plan was put together without much input and is not likely to pass through the legislature in its present form. The CMA urges us to speak out and help shape the impending legislation.
But while the governor’s plan is a work in progress, a new law, AB 774, came into our lives effective Jan. 1. I’m happy to report that SHC meets or exceeds the new requirements of AB 774, sometimes called California’s New Charity Care and Discount Payment Law.
The new rules mandate that hospitals (not physician practices) adopt written discount and charity policies. AB 774 limits debt collection practices, such as credit reporting, garnishing wages, filing liens on primary residences or forcing foreclosure. The law also prohibits an institution from charging installment loans. Hospitals must explain their charity care practices to patients in writing.
The law was meant to stop hospitals charging “full freight” to uninsured patients with modest finances. Eligible are lower income patients who must self-pay because they are not eligible for Medicaid (Medi-Cal), third-party insurance, workers compensation or other sources, such as auto insurance.
The policy applies to self-pay families, including those whose insurance has tapped out, or whose income is at or below 350 percent of the federal poverty level. The hospital cannot collect from these patients more than what Medicare, Medicaid or Healthy Families would pay. For the purpose of establishing financial eligibility the hospital can only consider income and not assets, such as the family home.
Stanford has always provided care for patients needing emergency services and no financial screen ever applies to patients subject to EMTALA.
(See my June 1997 Update column:
http://med.stanford.edu/ shs/update/archives/june97/shuer.html
[But don’t look at my picture there!]).
Overall, our policy is to work closely with patients who demonstrate a financial need. Here’s how it works:
Patients complete a mandated financial screening exam after receiving stabilizing treatment.
Counselors will see if the patient can qualify for Medi-Cal or other safety net program before receiving, if qualified, a financial need discount from SHC.
Stanford defines a “patient with high medical costs” as one whose family income does not exceed 400 percent of the federal poverty level (a lower qualifying bar than AB 774) and where out-of-pocket expenses exceed 10 percent of the patient’s family income in the prior 12 months. Patient families are defined broadly to include domestic partners and dependent children who live away from home.
Charity care and financial discounts at Stanford are not automatic and are evaluated case by case. Patients must apply and are prioritized according to the emergency or seriousness of care and the proximity to the patient’s home or work to SHC. Also taken into account are SHC’s expertise for what the patient needs, research or teaching needs, and of course, the Hospital’s current resources.
SHC is doing its best to provide compassionate care, meeting or exceeding our legal obligations, while ensuring the institution’s financial survival. However, changes are in the wind outside our doors, and they require our attention. The best policy that we can come up with can be easily hobbled by statewide dysfunction. We can influence that broader picture.
For questions about what we are doing already, including details about SHC’s Charity Care Policy, consult the Administrative Manual, or contact a representative from patient financial services through your service. Patients may contact patient financial services for assistance at (800) 549-3720. Let’s all be current about what is available and what we can do to help patients who might otherwise fall through the cracks.
Meanwhile, the governor’s plans are still a work in progress. I urge you to get involved and to note that we as a hospital are already trying to be part of the solution through our policies. We are anxious to brainstorm and continue to find creative answers in a complex environment that brings together politics, medicine, economics, and crucially, the needs of our patients.
A good first step is to contact the CMA:
http://www.cmanet.org/publicdoc.cfm/8
Some of the suggestions proposed during the governor’s State of the State Speech in January have triggered a furor among many of our colleagues. Clearly, the governor didn’t reference the specific policies that Stanford has adopted to help patients secure access, but some of the things we are doing resonate clearly with what the governor says and deserve our active attention. I’ll say more about these local policies in a minute. But first, let’s look at the statewide agenda.
In his Health Care Proposal for California, the governor reminded us of our rights and obligations as physicians and then went on to talk about the challenges of patient access. He said the system is broken, because:
A large segment of the population is uninsured. Many of the uninsured are employed but have no employee healthcare option. (Sorry, folks, more jobs are not the solution). Californians with health insurance confront a “hidden tax” because they pay higher insurance premiums and medical costs to subsidize the healthcare of their fellow citizens who lack coverage. Emergency departments are closing across the state for various reasons, including their high costs of operation. Health costs are rising because of such dysfunctional phenomena as preventable chronic diseases, medical errors, and the overhead costs of caring for the uninsured.Schwarzenegger outlined a broad initiative to reduce the hidden tax, lower costs, support better care, and work toward a healthy California.
The proposal, still in outline form to be configured by the legislature, includes:
Improved prevention programs for obesity, smoking prevention and diabetes to bring down the costs of preventable chronic illness. He suggested possible incentives for consumers to adopt healthy activities and practices. Recommendations to reduce medical errors by adopting e-prescribing for all outpatient medicine in the state. A call to strengthen patient safety and accountability.And, last but not least, is the point which has hit the hot button for many physicians and hospital administrators: the governor hopes to make insurance affordable for all through what he calls “shared responsibility.”
Schwarzenegger proposed a tax of 2 percent of all physicians’ revenues and 4 percent of all hospital revenues to help fund an expanded Medi-Cal program. It’s based on a complex formula of income but would be weighted toward trying to make sure that all California children are covered. The proposal would cover all children in families earning less than 300 percent of the federal poverty level (about $60,000 yearly depending on family size) and would add more adults below the poverty line. Subsidies would enable low income families to participate in an insurance purchasing pool. The “carrot” for hospitals and physicians is a $4 billion increase in Medi-Cal reimbursement rates.
We all want more health care access, especially for children. However, the devil is in the details, notably, how will the governor’s proposal be funded fairly?
Many physicians have reacted by putting up the barricades. But not so fast.
A week after the governor’s speech, I traveled to the state capital to attend the annual meeting of the California Association of Neurosurgeons (CANS), my specialty society concerned with the socioeconomic happenings for neurosurgeons practicing in our state.
Representatives from the California Medical Association spoke at our CANS meeting and suggested that we as physicians should not overreact to the darker side of the governor’s proposal. The CMA believes that Schwarzenegger’s plan was put together without much input and is not likely to pass through the legislature in its present form. The CMA urges us to speak out and help shape the impending legislation.
But while the governor’s plan is a work in progress, a new law, AB 774, came into our lives effective Jan. 1. I’m happy to report that SHC meets or exceeds the new requirements of AB 774, sometimes called California’s New Charity Care and Discount Payment Law.
The new rules mandate that hospitals (not physician practices) adopt written discount and charity policies. AB 774 limits debt collection practices, such as credit reporting, garnishing wages, filing liens on primary residences or forcing foreclosure. The law also prohibits an institution from charging installment loans. Hospitals must explain their charity care practices to patients in writing.
The law was meant to stop hospitals charging “full freight” to uninsured patients with modest finances. Eligible are lower income patients who must self-pay because they are not eligible for Medicaid (Medi-Cal), third-party insurance, workers compensation or other sources, such as auto insurance.
The policy applies to self-pay families, including those whose insurance has tapped out, or whose income is at or below 350 percent of the federal poverty level. The hospital cannot collect from these patients more than what Medicare, Medicaid or Healthy Families would pay. For the purpose of establishing financial eligibility the hospital can only consider income and not assets, such as the family home.
Stanford has always provided care for patients needing emergency services and no financial screen ever applies to patients subject to EMTALA.
(See my June 1997 Update column:
http://med.stanford.edu/ shs/update/archives/june97/shuer.html
[But don’t look at my picture there!]).
Overall, our policy is to work closely with patients who demonstrate a financial need. Here’s how it works:
Patients complete a mandated financial screening exam after receiving stabilizing treatment. Counselors will see if the patient can qualify for Medi-Cal or other safety net program before receiving, if qualified, a financial need discount from SHC.Stanford defines a “patient with high medical costs” as one whose family income does not exceed 400 percent of the federal poverty level (a lower qualifying bar than AB 774) and where out-of-pocket expenses exceed 10 percent of the patient’s family income in the prior 12 months. Patient families are defined broadly to include domestic partners and dependent children who live away from home.
Charity care and financial discounts at Stanford are not automatic and are evaluated case by case. Patients must apply and are prioritized according to the emergency or seriousness of care and the proximity to the patient’s home or work to SHC. Also taken into account are SHC’s expertise for what the patient needs, research or teaching needs, and of course, the Hospital’s current resources.
SHC is doing its best to provide compassionate care, meeting or exceeding our legal obligations, while ensuring the institution’s financial survival. However, changes are in the wind outside our doors, and they require our attention. The best policy that we can come up with can be easily hobbled by statewide dysfunction. We can influence that broader picture.
For questions about what we are doing already, including details about SHC’s Charity Care Policy, consult the Administrative Manual, or contact a representative from patient financial services through your service. Patients may contact patient financial services for assistance at (800) 549-3720. Let’s all be current about what is available and what we can do to help patients who might otherwise fall through the cracks.
Meanwhile, the governor’s plans are still a work in progress. I urge you to get involved and to note that we as a hospital are already trying to be part of the solution through our policies. We are anxious to brainstorm and continue to find creative answers in a complex environment that brings together politics, medicine, economics, and crucially, the needs of our patients.
A good first step is to contact the CMA:
http://www.cmanet.org/publicdoc.cfm/8
