Oregon has new standard to apply for financial help
Access managers say it’s unprecedented
In what appears to be an unprecedented effort, hospitals throughout Oregon have agreed to use a standard form for patients to apply for financial assistance. As part of the collaborative effort, the hospitals have said they will post prominent signs and offer pamphlets and bilingual business cards telling patients how to apply for the monetary help, explains Barbara Wegner, CHAM, regional director of access services for Providence Health System in Portland. Prompted by a consumer group, the initiative began with four hospitals in the Salem area and then moved to Portland, Wegner says. "It’s nationally unprecedented," she adds, "that competing hospitals would get together and do something this substantive for patients who don’t have coverage." Although Providence and other nonprofit health care organizations already had procedures for applying for financial help, the agreement makes the process simpler for patients and for access personnel, Wegner points out. "If a patient had been seen recently at another facility and had filled out a form, that person could present the form to a registrar and help facilitate the whole process." In line with the guidelines, she says, Providence makes business cards available in waiting areas to inform patients of the financial assistance program in four different languages - English, Vietnamese, Spanish, and Russian. Applications also can be translated into other languages as needed, Wegner notes. The project had its impetus about two years ago, when an advocacy group called the Oregon Health Action Campaign (OHAC) did a study to identify barriers to health care, says Tim Miller, MA, program manager and organizer for the Salem-based group. "One of the problems we discovered was that people accessing health care didn’t know anything about charity care or free care," Miller notes. Although nonprofit hospitals are not explicitly required to give charity care per se in exchange for their exemption from income and property taxes, he explains, they must by law provide "community benefits." Those benefits can take various forms, such as supporting a women’s clinic, for example, or providing free care to those unable to pay, Miller adds.
Nothing was uniform’
In the course of the study, he says, OHAC documented several cases of patients who would have been eligible for charity care according to the guidelines of the hospitals who treated them, but never learned about that option. Instead, they accumulated huge debts, were threatened by collections agencies and, in one case, declared bankruptcy, Miller says. "The law is there, but the hospitals had different ways of [fulfilling] it and different standards," he adds. "Nothing was uniform. The community didn’t know about it, and wouldn’t know unless they found out by accident." After hearing about the study findings, Miller says, the Salem hospitals, and later the Portland hospitals, agreed to work on a uniform charity policy. Eventually, the Oregon Association of Hospitals and Health Systems (OAHHS) adopted a voluntary agreement that set the standard for all Oregon hospitals in regard to free care, he says. (See "Here’s how the Oregon program is set to work") The OAHHS board approved a booklet developed by the Portland hospitals, "Financial Assistance Guidelines: A Suggested Policy for Oregon Hospitals," for distribution statewide. When the issue came before the OAHHS board about a year ago, the hospital association saw it as an opportunity to suggest common language that could be used in hospitals across the state, says Karen Normandin, communication director for the Lake Oswego-based association. "It took several months to hash over definitions and come up with a set of guidelines and to make the information available in several languages." There’s also an element that has to do with employee education, Normandin notes. Employees in admitting, emergency department, and clinic areas are to be prepared to provide information on the program, she adds. "When eligible consumers are in the organization, they can ask questions about financial help, and [these employees] can direct them." Plans are, Normandin says, for participating hospitals to get back together in a year and see how the program is doing. "One of the purposes is to network and collaborate so that everyone benefits." From Miller’s point of view, "the bad part [of the program] is that it’s only voluntary. The good part is, it’s the first agreement on a statewide basis in the nation."
His organization’s next step, he says, is to determine what can be done to make sure all hospitals participate. However, Normandin says the financial assistance guidelines "would be pretty complicated to mandate. We have about 65 member hospitals, and about 40 of those are small, not as stable [as the larger participants]. It’s a different situation in a lot of communities. We’re participating in it as a voluntary program." Oregon residents who make less than 150% of the federal poverty level — about $27,000 for a family of four — are eligible for the Oregon Health Plan, the state’s health insurance plan for the poor. But they may be excluded for other reasons — for example, if they have more than $2,000 in cash or bank accounts. The voluntary guidelines adopted by the Oregon hospitals state that financial assistance generally is secondary to all other financial resources available to the patient, including insurance, government programs, third-party liability, and assets. They also state, however, that full financial assistance usually will be provided to a responsible party with gross family income at or below 150% of the Federal Poverty Guidelines. Under the newly adopted policy, uninsured patients with incomes between 150% and 200% of the poverty level are eligible for aid on a sliding scale to help pay hospital bills. The details of that scale are left up to each hospital, says Normandin. The financial assistance given is specific to each admission, and the patient will be screened for changes in eligibility when there is a readmission or new episode of care, Miller says. However, Normandin indicates, that screening process is greatly streamlined by the standardized application form. "My understanding is that the patient would have a copy of what was filled out [for earlier hospital visits], and that the information would be transferrable. "There is a shared responsibility on the part of the patient and the person helping the patient fill it out," Normandin adds. "There is a requirement in the guidelines that the form be filled out completely." The effort has generated "lots of positive comments," she says. "Folks are enthusiastic about using common language and not having to reinvent the wheel." And, she points out, "[providing assistance] is part and parcel of their mission."
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