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Hospital services pre-payment may loom large in future

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collecting prior to care
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Recently, we've covered a variety of news that touched on the issue of whether hospitals should get tough about collecting from patients prior to delivering care for elective procedures. Most of it suggests that this is a risky strategy, at least politically:

*  The Wall Street Journal ran a very unflattering piece on the M.D. Anderson Cancer Center's decision not to treat a leukemia patient until she coughed up $100,000 in cash.

* Perhaps in response to the WSJ story--or others like it--the Minnesota legislature just passed a measure forbidding the state's hospitals from investigating a patient's medical debt prior to treating them.

* According to one blog, an ED surgeon recently was sued under EMTALA because he gave a patient a realistic estimate of costs during treatment and the patient went elsewhere.

This is a difficult situation, and it's going to get nastier, particularly if reform-minded types take over the White House this year. Why? Because historically, hospitals have been asked to carry many of the costs of system, and policy-makers don't always bear in mind that they don't have the resources.

On the other hand, hospitals aren't completely helpless. As our sister publication, FierceHealthFinance, points out, hospitals often can do much more to qualify patients for various forms of charity care and public assistance, as well as collect from self-pay patients after the fact. That, at least, is a start.

Other than that, I suspect it's time for even the least politically minded hospital executives among us to become active. Make your case on the local, state and even federal level. Otherwise, our political leaders may continue to assume--as some seem to now--that you're the bad guys. - Anne

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Get rid of the not-for-profit status for hospitals and let them compete with doctors, free standing clinics and anyone else who can stand up to them. Alternatively allow doctors like me who treat over 15 % of our patients for no fee or highly reduced fee to get a non-profit status or at least a tax write off for the losses. That will solve the problem of poor access and affordability of care in this country.

The allegation against M.D. Anderson Cancer Center was even more disturbing---that the patient was in the MIDDLE of a chemotherapy session, and the nurse would not hang the next IV bag without permission from the business office.

I am surprised that no news organization realized that M.D. Anderson has a code of ethics, and that the final portion states:

Principle 10
Cancer therapy, prevention, education, and research are costly endeavors demanding conscientious stewardship; however, financial considerations should not dictate the quality of care offered to each patient.

Ironic.

Dr. Murali's comments (above) are right on the mark. What is needed is thinking outside of the box, the box being the current payment structure for medical services, whether reimbursed or not.
John Marshall,an early Chief Justice of the Supreme Court, wrote that "the power to tax is the power to destroy".
The reverse is also true today. Tax deductions and tax rebates can also create. Physicians and for-profit hospitals both pay taxes on the income generated from their services. Permitting them to take 100%+ tax writeoffs on unreimbursed or under-reimbursed services would enable them to perform these services at no cost or at a reduced cost (using, say, the Medicare reimbursement rates as the benchmark). The tax writeoffs could be in the neighborhood of 125% of the Medicare reimbursement for the particular procedure. Effectively, assuming that the physician or hospital would have accepted the Medicare fee schedule, then performing the service 'for free' would actually turn a profit, allowing a 25% reduction in taxation for other services performed and paid for.
What is needed is creative, 'out of the box' thinking. The old models don't work anymore in this day and age. Simply throwing money at the problem will not solve anything. The failed British and Canadian healthcare systems demonstrate that. New ideas need to be put forward.
By new people.

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