Quality Care and the Bottom Line


Posted to Nursing, Nursing News

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Uncompensated health care is a major issue for hospitals, with an estimated $39.3 billion of care going uncompensated in 2010. The size of this financial burden has forced hospitals to use more creative debt collections, such as asking for payment at time of service versus asking solely for insurance information.

Hospital debt has lead to the development of companies like Accretive Health. Accretive Health states on it’s website, “Accretive Health increases access to care by bringing increased discipline to the revenue cycle.” Non-profit health care organizations would all agree that a positive revenue cycle allows them to fulfill their missions. But how they collect “bad debt” has become the challenge and the legal question.

For many, the hospital is seen as a “sanctuary to treat the sick and infirm” as stated in a report by Minnesota’s Attorney General, Lori Swanson. Swanson has been working to push the issue of debt collection in health care to the forefront, forcing us to wonder what can and should hospitals be doing to address bad debt with the hope of remaining financially stable. It’s important to keep the doors open, but how to best do this?

An ill patient who is asked about payment before care is given may understand or hear the question, “how would you like to pay for your care today” very differently then a patient asked the question after care is provided. And a patient who is able to hand the hospital staff member a health insurance card is likely to have a different level of stress then one who does not have this option.

Nurses, who do not routinely have knowledge of patients’ insurance coverage or ability to pay, need to be aware of the practices being used by their employers to decrease bad debt. As the first health care professional the patient is likely to encounter after completing registration or checking in, nurses are in a key position to reassure patients that the quality of the care they will receive is not based on their ability to pay.

The nurse does this by showing the patient respect and dignity; answering questions about cost and billing honestly; and seeking help from any internal resources available in the organization, such as Social Services, a financial counselor, or a pharmacist. The nurse can also act as a patient advocate in relationship to treatment plans. The selection of a less-expensive dressing or stoma pouch versus selecting the clinic or hospital standard could mean dollar savings for a patient, with no decrease in quality.

Nursing as a profession has the responsibility to understand both sides of the bad debt issue. Advocating for patients to receive quality care regardless of ability to pay is important. However, nurses will fail patients if this is their only involvement. Nurses also can be active in quality improvement and resource projects directed at reducing cost and length of stay for patients. These are the actions that will provide our national health care with sustainable choices by addressing the cost of health care for all patients.