Care for all

Hours after Patti Thompson slipped and fell on her icy driveway Tuesday, she was back at work and hoping her injured right arm would heal on its own.

But it didn't, and when Thompson awoke Wednesday morning with more swelling, the Cedar Rapids woman decided she needed to have it looked at - even though she's uninsured.

“It's scary to be without health insurance,” Thompson, 49, said while resting in an emergency room bed at Cedar Rapids' Mercy Medical Center on Wednesday. “I didn't know how I would be treated. But they've been really super sweet.”

The number of uninsured or underinsured people like Thompson who can't pay for some or all of the health care they receive is rising in hospitals across Iowa, according to the Iowa Hospital Association. That is driving up the amount hospitals are paying in uncompensated care, which includes the cost of care provided to people who can't pay their bills due to mounting debt problems or who need charity care or discounted services.

The Hospital Association's 118 member hospitals in the 2010 budget year provided $851.2 million in care for which the facilities were not fully compensated, according to the association. That is up 6.3 percent over 2009, and it's up 70 percent from 2000, when Iowa's hospitals paid $252 million in uncompensated care.

A weakening economy largely is to blame for the increase, according to Scott McIntyre, director of communications for the Iowa Hospital Association.

“There are lots of people who suddenly don't have insurance,” McIntyre said. “And our entire medical system is built around the idea that people have insurance.”

Rising uncompensated care costs are a concern for hospitals, including non-profit facilities that make charity care part of their mission, largely because some uninsured or underinsured patients don't apply for designated financial aid and - in the process of leaving hospitals with unpaid bills - end up with bad debt.

“Folks need to be honest about their situations so we can go through the steps of getting them qualified (for financial aid),” McIntyre said.

Hospitals in Eastern Iowa recently enacted measures to reduce the number of people incurring debt while strapping the facilities with unexpected uncompensated care costs.

University of Iowa Hospitals and Clinics, for example, added social workers and a health care benefits assistance program coordinator to its emergency department, which handles most of the uninsured patients.

St. Luke's Hospital in Cedar Rapids created a unit dedicated to helping patients identify funding sources, including options through Medicaid.

Mercy Medical Center in Cedar Rapids added four counselors to its emergency department to work around the clock with patients needing financial aid. It also started a program that catches patients who should have applied for assistance and gets them lined up with financial aid before unpaid bills ding their credit.

On top of the benefit to uncovered patients, hospitals are eager to help more people find a way to pay - be it through charity care, Medicaid or veterans services - because unforeseen uncompensated care costs can have a ripple effect on other services, McIntyre said.

“When hospitals have to cover expenses unexpectedly, they are not able to do things they have plans for,” he said.

Eventually, McIntyre said, uncompensated costs can affect insured patients too, driving up premiums, for example.

Although the value of uncompensated care at Mercy Medical Center is higher than it was in 2009, the number of patients incurring bad debt has dropped to zero thanks to the hospital's new program geared toward helping patients apply for charity care, officials said.

“We put counselors on every shift to help find patients and get them to apply,” said Shawn Steffen, senior director of revenue cycle for Mercy.

In addition to charity care, more people these days are qualifying for Medicaid, but that doesn't always solve the uncompensated care problem, said Milton Aunan, vice president and chief financial officer at St. Luke's.

“More people are covered under Medicaid, but Medicaid doesn't cover everything,” Aunan said.

At St. Luke's, he said, the value of uncovered care for Medicaid patients has jumped from $7.9 million in 2007 to $13.2 million in fiscal 2010. Still, Aunan said, the efforts to get patients qualified for some type of financial aid is paying off in that fewer individuals are incurring bad debt.

“And we are finding that as we use and improve our collection efforts, there are individuals who can pay their health care bills,” he said.