Like colleagues at nine other major hospital systems, administrators at the Mayo Clinic spent last week trying to figure out how to meet a sudden and fast-arriving deadline imposed by members of Congress.
"We're coming up with our game plan," said Chris Gade, a spokesman for Rochester, Minn.-based Mayo. "Will we make it by the date given? We're going to try. It's a pretty big request."
The House Energy and Commerce Committee last week gave the country's 10 largest hospital companies until May 13 to provide records detailing the bills they sent to certain groups of patients treated at their facilities, as part of a probe of uninsured billing practices. Once the records are received, the committee will review them before determining its next step.
The targeted systems include both not-for-profits and for-profits, including the nation's largest not-for-profit hospital system, Ascension Health.
"We agree that hospital bills should be clear, concise, correct and patient friendly," said Susan Nestor Levy, a senior vice president at Ascension. "Healthcare consumers should be given every opportunity to understand exactly what they are paying for and how much they are being asked to pay." She said the system supports the committee despite the looming deadline and is trying to figure out the most efficient way to meet its requests.
House Energy and Commerce Committee members described the April 26 letter sent to the systems as the most recent phase of a look at the complexity of hospital billing and at the impact that payment disparities have on uninsured patients or those who rely on health savings accounts, or HSAs.
"There's no reason to believe any of these companies are in the wrong on this issue," a committee spokesman said. "The committee simply wanted to start with the 10 biggest."
Other systems that received letters were Adventist Health, Roseville, Calif.; Catholic Health East, Newtown Square, Pa.; Sutter Health, Sacramento, Calif.; New York-Presbyterian Healthcare System, New York; HCA, Nashville, Tenn.; Catholic Health Initiatives, Denver; Tenet Healthcare Corp., Dallas; and Catholic Healthcare West, San Francisco.
The letter requests that each system provide the first 500 items that appear on the current chargemasters of the three largest hospitals under their control. The items should include "any and all service or supply descriptions, associated codes or references, and associated prices or charges."
Systems were also asked to provide their out-of-network gross billings per patient day; the net revenue collected per patient day; and the total number of patient days beginning Jan. 1, 2000, and for each subsequent year.
Other requests include an explanation of each type of patient billing record created by the hospital system and under what circumstances each record is created.
There are also a handful of questions included in the letter, such as, "Do patients ever pay prices based on a chargemaster for out-of-network services? If so, is this ever at or near the full chargemaster price?"
Gade said Mayo has been cooperating since the committee began looking into healthcare billing practices two years ago. "We understand we were asked to supply our records based on our size, not for any punitive reasons," he said.
The latest requests follow a June 2004 hearing of the panel's subcommittee on oversight and investigations. At that hearing, witnesses accused hospitals of charging patients more for care than what insurance companies routinely pay for the same services.
The American Hospital Association said last week that it has shared the committee's letter with its members. The AHA also noted that about 4,100 hospitals are following guidelines for billing it proposed in December 2003. Those guidelines state that "Hospitals should use a billing process that is clear, concise, correct and patient-friendly."
Coinciding with the release of the letter, Energy and Commerce Committee Chairman Joe Barton (R-Texas) released a statement saying that patients having no insurance or using HSAs "shouldn't be taken to the cleaners." He also mentioned complicated hospital billing statements that "might as well be in a foreign language."
In response, the AHA noted that a recent study it co-commissioned with the Federation of American Hospitals showed that 95% of HSA and health reimbursement account, or HRA, enrollment is in plans that build on insurance companies' existing provider networks and negotiated rates, creating what it calls "a level playing field" for patients' costs.
HSAs are employee-owned accounts that follow employees from job to job. They are offered as part of a high-deductible health plan, and employer and employee contributions are tax-deductible up to a certain amount. HRAs combine high-deductible coverage with employer-funded accounts from which employees can pay a portion of their healthcare expenses.
Seven out of 10 employers expect to offer consumer-driven or self-pay coverage by next year, the AHA predicts.
The June 2004 committee hearing addressed the effect of hospital billing policies and practices on uninsured and self-pay patients enrolled in HSAs and HRAs, and the committee's subsequent investigation also looked at hospitals' collection practices. In February, the committee sent a letter to the five largest U.S. hospital systems to gauge progress in the collection matter.
"We now follow up 1/4 (to see how) hospitals set their charges," stated the April 26 letter. "We turn now to the manner in which those charges are presented, explained and understood by the consumer through patient billing records."