Can Hospitals Afford NOT to Be Ready for Disaster?

Pendleton Memorial Methodist Hospital stands partially submerged in flood waters on Sept. 8, 2005, in east New Orleans, La., in the aftermath of Hurricane Katrina. (James Nielsen/AFP/Getty Images)

Pendleton Memorial Methodist Hospital stands partially submerged in flood waters on Sept. 8, 2005, in east New Orleans, La., in the aftermath of Hurricane Katrina. (James Nielsen/AFP/Getty Images)

Baton Rouge   The headline caught my eye. Sheri Fink, author of what has to be the definitive case study of a hospital in crisis post-Katrina, the award-winning Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, had written an op-ed piece in the Times entitled, “Can Hospitals Afford to Be Ready for Disaster.” You can probably already see my head scratching. I had written a book about Katrina myself, The Battle for the Ninth Ward: ACORN, Rebuilding New Orleans, and the Lessons for Disaster. The one lesson I felt confident of was that we finally had a national, and certainly a community, consensus that we had to be ready for disaster, so for me the question was really, “Can Hospitals Afford NOT to be Ready for Disaster?”

The issue was an important one that is now lost in the bureaucratic maze. The Bush Administration started the wheels turning in 2007 post-Katrina and the Obama Administration proposed a draft for public comment in 2013. The language is stuck now in legal review at the Office of Management and Budget (OMB) on an extension of a 90-day legal review. The whole rule though is on a 3-year timetable, so if not finalized, we’re left with nothing.

You might say, “…but that can’t happen here.” We’ve had Katrina, Sandy Hook, Ebola, and now Zika all highlighting the need for disaster preparedness and, worse, proving over and over again how few health care facilities are ready and able. Please remember the Katrina situation involved nursing homes so unprepared for evacuation that many elderly were trapped and drowned. Memorial Hospital, the old Baptist facility, was in such a crisis mode as Fink has documented that “two desperate doctors later said that they hastened the death of patients who had waited days in the heat for rescue.” Reading the book, there was little doubt that many of these patients would have had years left to live had there been a different set of responses.

The rule would change much of those worries. It would affect 68,000 providers across the whole range of the health care industry and not just hospitals and nursing homes but kidney dialysis centers, mental health facilities, home health and the whole shebang.

So, this is a no-brainer, right? Well, it should be but you’ve already probably guessed that it would be if we had a public health system, but with a private dominated healthcare system if administrators can avoid spending the money, then emergency preparedness is at the bottom of the list. Fink even noted that there are 250 California hospitals that have still not been “retrofitted, replaced, or removed from service” 45 years after the Sylmar earthquake killed dozens at California hospitals. A professor in Maryland noted that an administrator was probably calculating that if they had to spend a couple of hundred thousand and they never had a disaster, then they lost revenue. This is topsy-turvy of course. You spend to prepare, while hoping you never have to meet a disaster. The same prof though noted that if the facility spent the money and faced a disaster and were ready, they would make a killing, but “how do you do a budget analysis on that?” Wow! The warped priorities here just takes your breath away, and where is Senator Charles Grassley from Iowa when we need him reminding so many of these facilities that they are tax exempt so why is “making a killing” a priority anyway!

We need this rule and probably a lot more. Time to Boy Scout up and get in touch with your Senators and Congressmen to reach out to the OMB and the Department of Health and Human Services and remind them that “Be Prepared” is not just a slogan, but a lifesaver!

Facebooktwittergoogle_plusredditpinterestlinkedinmail

Hospitals Shirking on Financial Assistance

view-overall-inpatient-billKiln, Mississippi    When the doctors’ union, the American Medical Association Journal of Ethics rings the bell on the horrid practices of hospitals, you know we have a tiger by the tail – and we’re in danger of continuing to be hurt badly!

The Journal looked at 140 hospitals to see how they were preparing for the mandatory rule taking full effect this January under the Affordable Care Act of providing financial assistance to lower income families. What they saw wasn’t pretty, although we could have told them that from our close inspection of many hospital IRS 990 forms in Texas, Louisiana, Arkansas, and other states.

First the Journal confirmed the fact that finding the information, even for them, and certainly this has been the case for us, was like finding a needle in a haystack. They looked at a random sample of 140 hospitals across fourteen states. In their survey, they found that half of the institutions did not say on their websites whether they were public, private, or nonprofit. Needless to say, their reporter was web savvy which also wouldn’t be true of many families desperate to find if the hospital offered any help. So, transparency, not! Also, not surprisingly, they found that for-profit hospitals generally had not voluntarily created financial assistance policies in line with what nonprofit, tax exempt hospitals are now required to do.

But here comes the real rub in what the Journal found and it goes to the heart of the vagueness of the IRS requirements for financial assistance in this new rule:

…hospital financial assistance policies vary significantly in terms of generosity and terms. Among the sample of financial assistance policies from 140 hospitals, eligibility cutoffs for financial assistance ranged from an income of 100 percent of the federal poverty level (FPL) to 600 percent of the FPL. Many hospitals with financial assistance policies offered free care to those with incomes up to 100-200 percent of the FPL and sliding scale discounts above that threshold. However, some hospitals did not offer any free care and only offered moderate discounts even to the poorest patients. Of the hospitals in the sample that provided eligibility information based on insurance status, a quarter excluded those with insurance from their financial assistance policies altogether.

Bottom line, if your wallet is a bit light, you better start doing some research so that when you get sick you can find that 600% hospital or you are up a creek with no paddle. And, for those hospitals that exclude any lower income family from financial assistance if they have any insurance at all regardless of the deductible, we, and all those like us, need to start figuring out a way to challenge their tax exempt so-called charitable status.

The Journal was also clear about the hospital rip that starts with the “rack” rates for cares or charge master rates.

Hospitals routinely charge uninsured patients undiscounted “chargemaster” prices, the “rack rates” or list prices of the health care industry, while government and commercial payers receive substantial discounts of 50 percent or more of the chargemaster prices for their members

Yes, you are hearing this right. If you are covered with insurance, your bill is discounted. If you are uninsured and out of luck, your bill is essentially doubled!

The Journal argues that California provided a model that would have been immeasurably better and that has worked well for hospitals and patients in that state.

California’s Hospital Fair Pricing Act… limits how much California hospitals may charge uninsured patients who earn less than 350 percent of the FPL or insured patients whose medical bills exceed 10 percent of household income

Unless a miracle happens in the next several months, like the old song, we’re all going to wish we were living in California. When the doctors of all people in the AMA start calling out hospitals as bloodsuckers, you know we’re in a fight for our lives.

***

Please enjoy the Wallflowers’ Back to California

Facebooktwittergoogle_plusredditpinterestlinkedinmail