Noam N. Levey
ROCHESTER, N.Y. — Jolynn Mungenast spends her days searching for methods to assist individuals pay their hospital payments.
Working out of a warehouse-like constructing in a scruffy nook of this former industrial city, Mungenast gently walks sufferers by way of medical health insurance choices, monetary support, and fee plans. Most need to pay, mentioned Mungenast, a monetary counselor at Rochester Regional Health. Very typically, they merely can’t.
“They’re scared. They’re nervous. They’re upset,” mentioned Mungenast, who on one current name labored with an older affected person to settle a $143 invoice. “They do think ‘I don’t want this to affect my credit rating. I don’t want you to come take my house.’”
At Rochester Regional Health, that received’t occur. The nonprofit system in upstate New York is considered one of only some nationally that bar all aggressive assortment actions. Patients who don’t pay received’t be taken to courtroom. Their wages received’t be garnished. They received’t find yourself with liens on their houses or be denied care. And unpaid payments received’t sink their credit score scores.
American hospital officers typically insist that lawsuits and different aggressive collections, although unsavory, are needed to guard well being techniques’ funds and deter freeloading.
But at Rochester Regional, ditching these assortment ways hasn’t damage the underside line, mentioned Jennifer Eslinger, chief working officer. The system has even been capable of transfer workers out of its collections division because it spends much less to go after sufferers who haven’t paid.
Eslinger mentioned there’s been one other profit to the change: rebuilding belief with sufferers.
“We think and talk a lot and strategize a lot about where is the distrust in health care,” she mentioned. “We have to remove that as a barrier to meaningful health care. We have to get the trust with the populations that we serve so that they can get the care that they need.”
‘Folks Cannot Afford This’
Rochester Regional, a big well being system serving a large swath of communities alongside the south shore of Lake Ontario, is large, with greater than $3 billion in annual income.
But in a spot the place once-mighty employers like Kodak and Xerox have withered, funds will be difficult. In 2022, Rochester Regional completed almost $200 million within the crimson.
Patients have their very own challenges. Unable to afford their payments, many ended up in collections, and even on the receiving finish of lawsuits. “We would go to court,” acknowledged Lisa Poworoznek, head of economic counseling at Rochester Regional.
Then, earlier than the pandemic, hospital leaders appeared extra intently at why sufferers weren’t paying.
The boundaries turned clear, Poworoznek mentioned: complicated insurance policy, excessive deductibles, and insufficient financial savings. “There are so many different situations that patients have,” she mentioned. “It’s really just not as simple as demanding payment and then filing legal action.”
Nationally, almost half of adults are unable to cowl a $500 medical invoice with out going into debt, a 2022 KFF poll discovered. At the identical time, the typical annual deductible for a single employee with job-based protection now tops $1,500.
Instead of chasing individuals who didn’t pay — a expensive course of that usually yields meager returns — Rochester Regional resolved to search out methods to get sufferers to settle payments earlier than collections began.
The well being system undertook new efforts to enroll individuals in medical health insurance. New York has among the many most sturdy safety-net techniques within the nation.
Rochester Regional additionally bolstered its monetary help program, making it simpler for low-income sufferers to entry free or discounted care.
At many hospitals, making use of for support is sophisticated — lengthy purposes that demand intensive details about sufferers’ earnings and property, together with automobiles, retirement accounts, and property, KFF Health News has discovered. Patients making use of for support at Rochester Regional are requested to reveal solely their earnings.
Finally, the well being system appeared for tactics to get extra individuals on fee plans so they might repay large payments over a 12 months or two. Importantly, the fee plans are interest-free.
That was a change. Rochester Regional, like another main well being techniques throughout the nation reminiscent of Atrium Health, used to rely on financing companies that charged curiosity, which may add 1000’s of {dollars} to sufferers’ money owed.
“Folks cannot afford this,” Poworoznek mentioned.
Ending ‘Extraordinary Collection Actions’
Working extra intently with sufferers on their payments allowed Rochester Regional to cease taking them to courtroom.
The well being system additionally stopped reporting individuals to credit score bureaus, a follow many medical suppliers use that may depress shoppers’ credit score scores, making it tougher to hire an condominium, get a automobile mortgage, and even get a job.
In 2020, Rochester Regional adopted a written coverage barring all aggressive collections by the system or its contracted assortment companies.
That put Rochester Regional in choose firm. A 2022 KFF Health News investigation of billing practices at 528 hospitals across the nation discovered simply 19 that explicitly prohibit what are referred to as extraordinary assortment actions.
Among them are main tutorial medical facilities, together with UCLA and Stanford University, but in addition group hospitals reminiscent of El Camino Hospital in California’s Bay Area and St. Anthony Community Hospital exterior New York City.
Also barring extraordinary assortment actions: the University of Vermont Medical Center; Ochsner Health, a big New Orleans-based nonprofit; and UPMC, a mammoth system based mostly in Pittsburgh. Like Rochester Regional, UPMC officers mentioned they had been capable of scrap aggressive collections by creating higher techniques that enable sufferers to repay their payments.
Elisabeth Benjamin, a vice chairman on the Community Service Society of New York, a nonprofit that has led efforts to limit aggressive hospital collections, mentioned there’s no purpose extra hospitals shouldn’t observe go well with, notably nonprofits which can be anticipated to serve their communities in alternate for his or her tax-exempt standing.
“The value is to promote health, to care about a population, to promote health equity,” Benjamin mentioned. “Suing people for medical debt or engaging in extraordinary collection actions is really anathema to all those values,” she mentioned. “Forget about your ‘cancer-mobile’ or your child vaccination clinic.”
Rochester Regional’s method doesn’t remove medical debt, which burdens an estimated 100 million people within the U.S. And fee plans like these the system encourages can nonetheless imply large sacrifices for some households.
But Benjamin applauded Rochester Regional’s ban on aggressive collections. “I give them big props,” she mentioned. “It never should have been allowed.”
New laws in New York now prohibit all medical payments from being reported to credit score bureaus and limit different assortment ways, reminiscent of wage garnishments.
Many hospital finance officers however say they want the choice to pursue sufferers who’ve the means to pay.
“Maybe it’s on a very specific case where there is an issue with someone just not paying their bill,” mentioned Richard Gundling, a senior vice chairman on the Healthcare Financial Management Association, a commerce group.
But at Rochester Regional’s finance workplaces, officers say they nearly by no means discover sufferers who simply refuse to pay. More typically, the issue is the payments are just too large.
“People just don’t have $5,000 to pay off that bill,” Poworoznek mentioned.
On her calls with sufferers, Mungenast tries to reassure the sufferers on the opposite finish of the road. “Put yourself in their shoes,” she mentioned. “How would it be if that was you receiving that?”
About This Project
“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the dimensions, affect, and causes of medical debt in America.
The sequence attracts on authentic polling by KFF, courtroom information, federal knowledge on hospital funds, contracts obtained by way of public information requests, knowledge on worldwide well being techniques, and a yearlong investigation into the monetary help and assortment insurance policies of greater than 500 hospitals throughout the nation.
Additional analysis was conducted by the Urban Institute, which analyzed credit score bureau and different demographic knowledge on poverty, race, and well being standing for KFF Health News to discover the place medical debt is concentrated within the U.S. and what elements are related to excessive debt ranges.
The JPMorgan Chase Institute analyzed records from a sampling of Chase bank card holders to take a look at how clients’ balances could also be affected by main medical bills. And the CED Project, a Denver nonprofit, labored with KFF Health News on a survey of its shoppers to discover hyperlinks between medical debt and housing instability.
KFF Health News journalists labored with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was carried out Feb. 25 by way of March 20, 2022, on-line and by way of phone, in English and Spanish, amongst a nationally consultant pattern of two,375 U.S. adults, together with 1,292 adults with present well being care debt and 382 adults who had well being care debt previously 5 years. The margin of sampling error is plus or minus 3 share factors for the total pattern and three share factors for these with present debt. For outcomes based mostly on subgroups, the margin of sampling error could also be greater.
Reporters from KFF Health News and NPR additionally carried out lots of of interviews with sufferers throughout the nation; spoke with physicians, well being trade leaders, shopper advocates, debt legal professionals, and researchers; and reviewed scores of research and surveys about medical debt.
