SPECIAL REPORT: THROWAWAY WORKERS
No rush to claim cash for ER bills

Hospitals cite ethics, red tape as obstacles

By Stephen Franklin and Bruce Japsen | Tribune staff reporters
September 17, 2006

A controversial $1 billion federal program trumpeted as salvation for hospitals and others stuck with illegal immigrants' unpaid emergency care bills has largely gone unused.

Federal officials can't explain why overburdened communities have not grabbed the cash.

"We are really not certain why providers are not claiming the money," said Herb Kuhn, head of the government's Center for Medicare Management, which administers the program intended to distribute the $1 billion between 2005 and 2008.

Nationally, only 15 percent of the money has been handed out three-quarters of the way through the program's first year.

Related links

*
Special report

Throwaway workers

In Illinois, one of six states slated to receive the bulk of the money, just 6 percent of the $12.1 million available to hospitals, doctors and ambulances has been spent, according to figures from the U.S. Department of Health and Human Services.

None of that money went to Stroger Hospital, Illinois' largest public hospital where 40 percent of its patients' bills go unpaid. However, hospital officials told the Tribune last week that they plan to put in for the federal money.

In the meantime, some say the money should go elsewhere.

"Providing illegal aliens with free health care is an incentive for more illegals to come here," said Rep. Dana Rohrabacher (R-Calif.), one of the louder voices today calling for tougher immigration policies.

"Draining limited health-care funds to take care of illegal aliens and reimburse hospitals for their emergency care is ill-conceived and harmful to our own citizens. I will continue to oppose this kind of nonsense," he said in a statement last week.

While federal officials search for answers for the program's slow start and say they are optimistic it will work out, hospital officials, public health experts and immigrant advocacy groups offered several explanations.

The biggest deterrent to applying for the money, they explain, is concern about time-consuming paperwork that can offset any money gained.

Another is how the government calculates costs and often dramatically trims hospital bills. Federal officials say the cuts take place because hospitals often bill for their services and not their costs, and in some cases, seek funds for longer periods of stay than allowed.

Another problem for some is more of a moral issue, a concern by hospital officials that questions about immigration status will scare off already worried immigrants.

These hospitals are uneasy with the requirement that they document whether their patients are eligible for the federal money. It's an awkward process, the hospital officials say. They are told not to ask if someone is undocumented but to seek proof of birth outside the U.S. such as a driver's license, passport or birth certificate.

And though the federal form says patients' information will not be provided to immigration officials--except in cases involving suspected terrorism or crimes--some immigrant advocacy groups and health-care providers are skeptical of such promises.

Saying it wanted to protect patients' confidentiality about their immigration status, for example, New York City's health network, the nation's largest public health system, announced in November 2005 that it would forgo the federal money.

But federal officials were not aware of New York City's position last week when initially asked why less than $100,000 has been spent so far out of the $15.1 million available in New York state. They later acknowledged the New York City hospitals' confidentiality concerns and "strong immigrant advocacy" in New York that views the documentation as "onerous."

Sen. Jon Kyl (R-Ariz.), a key supporter of the funding, has been trying lately to find out why so little money has been used. Of a potential $47 million, only $5.1 million has been approved by the government for health-care providers in Arizona, government figures show.

"What is frustrating to me is that there is no constant response from the hospitals in Arizona to tell us what's happening," Kyl said.

The Arizona senator has no doubts about the need for the funding.

"Emergency rooms are stressed out for a lot of reasons," he said, adding that it is important they "be kept open for everyone."

Kyl also helped provide U.S. funds for a 2002 study that put the cost of unpaid emergency care bills for undocumented immigrants at about $190 million alone for hospitals along the nation's border with Mexico.

Hospitals' disinterest in the program comes at a time when many facilities are calling for more government support to help them deal with a growing number of poor and uninsured patients unable to pay their medical bills.

Earlier this month, the U.S. Census Bureau reported the number of uninsured Americans rose last year to a record 46.6 million, 15.9 percent of the total population. Meanwhile, the medical care that hospitals write off continues to soar.

"There are hospitals that say, `I am only going to get 33 cents on the dollar and then I have to hire people to complete these forms and house them.' They say it's not worth the effort," said Carla Luggiero, senior associate director for federal relations at the American Hospital Association.

"On the other hand, something is better than nothing so we are going to do it. There is a schism there," she added.

In Chicago, the area's largest provider of medical care, Advocate Health Care, said it has submitted claims on behalf of two of its eight hospitals: Advocate Trinity Hospital on the city's South Side and Advocate Illinois Masonic Medical Center on the North Side, where the bulk of the hospital operator's undocumented illegal immigrants are treated.

"We fully embrace the program and we set up systems to flag potential participants," Advocate spokeswoman Cynthia Pike-Fuentes said.

But, she added, the program has its shortcomings.

"If it is emergency care, we only get paid for two days until the patient is stabilized for inpatient [care]," she said.

If the patients stay any longer, the hospital has to swallow the rest of the bill, she adds.

Government figures show that Illinois Masonic submitted $1.3 million in payment requests to the federal government and received about $250,000 in reimbursements.

In addition to the paperwork burden and philosophical differences, the American Hospital Association said its members are leery of hiring additional workers.

""The return on their investment is inefficient," Luggiero said.

Sonal Ambegaokar, a health policy expert for the National Immigration Law Center in Los Angeles, said that the paperwork problems have led some hospitals to only submit bills for their most costly cases.

Lynn Fagnani of the National Association of Public Hospitals and Health Systems, says her group has been working with the government to iron out the paperwork and other issues.

While there has been progress, "the program continues to be problematic," she said.

Such problems add to the frustrations of public hospitals barely getting by. "When you are on the margin, every dollar counts," Fagnani said.

Dr. Francesca Gany of the Immigrant Health Center at the New York University School of Medicine said many health-care facilities there decided not to seek the federal money "because we want to make our facilities as friendly as possible to immigrants."

"It is not like there's a special New York state pot of money that is overflowing. It is the decision to consider the health of people as the primary mandate and not to scare people away."

But at Arizona's only public hospital, the Maricopa Integrated Health System in Phoenix, spokesman Gibson McKay says his facility views the $2.6 million it has received so far as "found money."

"We've got about 30 percent of what we submitted," he said. "And frankly, we are happy to get it."

----------

sfranklin@tribune.com

bjapsen@tribune.com

http://www.chicagotribune.com/business/ ... full.story