Undocumented immigrants would also be eligible for assistance.

PPH considering new financial assistance policies

By: ANDREA MOSS - Staff Writer

ESCONDIDO -- Proposed bill-discounting policies at Palomar Pomerado Health could reduce the rates uninsured patients pay for hospital services by up to 40 percent, according to information given to a key Palomar Pomerado Health committee Tuesday.

Some middle-income patients who have health insurance could also see their hospital bills reduced under the proposals. And patients who meet certain federal poverty guidelines could ask the district to write off their entire bills.

The policies, which still must be approved by hospital administrators, were laid out during a Palomar Pomerado Health finance committee meeting at the public hospital district's supply warehouse on Enterprise Street The health care district operates Palomar Medical Center in Escondido and Pomerado Hospital in Poway.

Marianne Van Winkle, a revenue manager for the health care district, told the committee the proposed policies would enable the district to comply with state Assembly Bill 774.

Signed into law last year, AB 774 is designed to keep hospitals from charging uninsured patients higher rates than insurance companies, Medicare or other government programs pay for similar services.

Palomar Pomerado already offers financial assistance to some of its patients and writes off some bills that go unpaid.

Assembly Bill 774 requires hospital districts to establish written financial assistance policies that cover more categories of patients and procedures for implementing those policies.

The financial assistance proposals discussed Tuesday would cover three groups of patients.

# Low- and middle-income patients who earn 350 percent or less than the federal poverty guidelines would qualify. Uninsured people who earn 250 percent or less than the federal guidelines could ask the district to write off their entire bills. Calculations by Van Winkle's staff showed a family of four whose annual household income was $51,625 or less would qualify for that type of financial assistance from the district, she said.

Patients who fall into the same financial category but have health insurance could get financial help with their share of their hospital bills, under the program.

And uninsured patients earning between 251 percent and 350 percent of the federal poverty guidelines could request discounts that would reduce their bills to levels equal to Medicare's reimbursement rates, Van Winkle said. A family of four with an annual household income of $51,626 to $72,275, for example, would be eligible for such discounts, according to information provided at the meeting.

# Uninsured patients who make too much money to qualify for the financial assistance program would also be eligible for discounts. Patients in this category could have their own bills reduced by 10 percent to 40 percent, depending on the payment method used and how quickly the bills were settled. Cash payments, for example, would cut those bills by 10 percent, while settling the bill within 30 days would an additional 30 percent "prompt pay discount."

Combined, those two discounts would lower the district's rates so they were comparable to the negotiated rates paid by MediCare, said Bob Hemker, chief financial officer for the district.

MediCare and private insurance companies often make deals with hospitals requiring them to pay less than full rates. The new rules will be designed to level the playing field for the uninsured, Hemker said.

"What you see ... is an effort to make it more equitable across the board," he said. "Basically, what this does is it established a negotiated contract with self-paying people. And if they breach that contract, (their bill) then goes back into the 100 percent category."

Those unable to pay within 30 days could still have their bills reduced by 20 percent if they signed up for and adhered to the terms of an extended payment plan offered by the district.

Undocumented immigrants would also be eligible for assistance.

Palomar Pomerado has received about $2 million since 2005 under a federal program that helps hospitals cover the costs of treating illegal immigrants. The proposed policies call for the district to submit quarterly requests for reimbursements from the government.

Patients would have to fill out written applications for any financial help before they could receive it. Van Winkle said she and Cindy Burns, patient services manager for the district, are working to set up training designed to make hospital staff members aware of the proposals and help them understand how they would work, so they can help patients request financial assistance.

Committee members questioned whether the policies might hurt Palomar Pomerado's bottom line. Van Winkle and Hemker, chief financial officer for the district, said that was unlikely because the district currently pays a collection agency to follow up on unpaid bills -- often with little or no success in getting the money owed.

Offering patients the chance to pay reduced amounts, on the other hand, seems to work better, they said.

-- Contact staff writer Andrea Moss at (760) 739-6654 or amoss@nctimes.com.

When do the handouts stop? Everyone in Florida knows not to feed alligators. Why? They will coming back and may eventually eat you or those in your neighborhood.

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