Partners Offers New Discounts for Uninsured

Two of the state's largest hospital networks, Partners HealthCare and UMass Memorial Health Care, will no longer routinely charge uninsured patients full ''sticker price" for medical care, but instead will offer 15 to 50 percent discounts, in some cases as much as the mark-downs large health insurers receive. The goals are to provide a price break for uninsured patients who earn too much money to qualify for state assistance and to make collecting payments from them easier. The new policies come at a time when hospitals across the US face criticism and lawsuits over aggressive billing methods and for routinely charging the uninsured far more for treatment than they do health insurers.

The Partners and UMass policies are among the first formal, publicized policies in Massachusetts that guarantee discounts to a broad group of patients and don't depend on patients requesting a markdown, and are among the most generous in the country, said consumer advocates. Partners includes Massachusetts General Hospital, Brigham and Women's Hospital, Newton Wellesley Hospital, Faulkner Hospital, and North Shore Medical Center; UMass includes UMass Medical Center in Worcester and four other smaller Central Massachusetts hospitals.

Hospitals routinely treat uninsured patients, who are required during their hospital stay to fill out a financial disclosure form. In some cases, hospitals enroll patients in the state Medicaid program. Patients who don't qualify for Medicaid but whose incomes are below a state-set maximum are covered fully or partly by the state's free-care pool. The pool reimburses hospitals for some or all of the patients' care. For uninsured patients with higher incomes, attempts by hospitals to collect payment are expensive and often unsuccessful. By charging these patients less, hospitals hope to increase collections, create a fairer payment system, and lessen the financial stress on uninsured families with staggering medical bills. About 100,000 Massachusetts residents are uninsured and have incomes above the state-set maximum and therefore don't qualify for free care, according to Governor Mitt Romney's office.

For routine care, Partners will give such uninsured patients a 15 percent discount off the full price of medical care if they pay their bill or agree to a payment plan within 60 days, and a 20 percent discount if they pay or agree to a payment plan within a month. Patients who require emergency or urgent care will receive a 50 percent discount if their medical bills exceed 30 percent of their annual income. Partners executives said about 2,000 of its patients annually are uninsured and don't qualify for free care. Both organizations said the discounts will apply to bills from doctors employed by the hospitals. The state's free-care pool applies only to hospital bills, but under the new policies such patients also will receive free or reduced care from the hospitals' doctors.

The UMass discounts take effect July 1, and the Partners policy starts Aug. 1.

Peter Markell, vice president of finance for Partners, said full hospital charges, which are based partly on what the hospital and doctor determine a particular service is worth, have long been used to cross-subsidize the state Medicaid program and other insurers that pay well below the hospitals' costs. Markell has said that practice makes it difficult to change the system. Yesterday, he said that executives have decided ''people deserve a break off the charges, no matter what."

-Adapted from“Hospitals cut costs for uninsured: 2 networks plan discounts of 15-50%”, by Liz Kowalczyk, The Boston Globe, June 23, 2005.

06/2005