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Nearly 40% of hospitals in Colorado do not meet regulations on informing patients about the state’s discounted care program on their website, according to a recent report from a consumer protection group.
An audit of the state’s 89 hospitals from the Colorado Consumer Health Initiative found that just 58% meet the complete regulatory website requirements for the hospital discounted care program. Patients are not always able to find accurate, thorough information about their financial assistance options for health care.
“We can do all the work in the policy space, but the policy is only as good as how it is implemented,” said Sophia Hennessy, CCHI’s policy and research coordinator. “Consumers need to know about it to be able to use it, and to use it well. It’s absolutely on hospitals to help notify them of their rights.”
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CCHI is a nonpartisan nonprofit that has helped pass legislation around health care consumer protection, including the 2021 discounted care program bill that went into effect in September 2022.
The program expands existing charity care law in the state and sets baseline requirements for financial assistance for uninsured patients under a certain household income level — currently about $51,000 for a two-person household. It sets limits on service charges based on a patient’s monthly income and then restricts payment plans to three years. Hospitals are required to screen all uninsured patients for financial assistance eligibility.
Advocates say it is critical to limiting or curbing medical debt in Colorado.
CCHI’s report, however, concluded that information about the program is not readily available online or over the phone at some hospitals. Researchers used a five-point rubric to score hospital websites, determining whether the hospital posted the Colorado Department of Health Care Policy and Financing patients’ rights form in English and Spanish, posted the discounted care uniform application in English, linked to information about discounted care on its landing page, and included information in a “conspicuous manner.” That generally mirrors the department’s regulations.
Researchers defined conspicuous posting as having the patients’ rights forms and application grouped together under a heading that read “Hospital Discounted Care.” That was the most frequent reason for point deduction, as 36 hospitals did not meet the standard.
“Broadly, we found that people are posting what they need to post. But then there’s a real barrier in terms of patients actually accessing that information,” Hennessy said.
Discounted care information is mentioned on Advent Health’s financial webpage, for example, in one sentence at the bottom of the page. CommonSpirit lists the uniform application separate from other discounted care materials in a bulleted list of financial assistance information.
The audit also found that speaking with a hospital representative on the phone about discounted care rarely resulted in a successful outcome. There are no regulations about phone calls and discounted care information, but CCHI included it in the report’s methodology to evaluate the experience of people with limited internet access or technological capability.
“People should be able to call the hospital before they’re a patient and before they have an appointment, and learn about it … especially in a climate where so many people are afraid to access care because of high medical bills
About half of the 178 calls researchers made led to a human representative, and 24% of those calls ended with an accurate discussion about discounted care and how to apply. Calls in Spanish had a lower success rate than those in English. The common administrative barriers included requiring an appointment or account before learning about financial assistance options.
The Colorado Hospital Association, which represents more than 100 hospitals in the state, criticized the phone call aspect of the report because it used secret shoppers and their experience.
“Colorado hospitals work diligently to comply with the hundreds of state and federal regulations, and compliance is a result of constant training and administrative work. Our hospitals continue to dedicate significant staff hours and resources to implement Hospital Discounted Care (HDC) requirements in their facilities, and the results are showing, as thousands of Coloradans have received care through this program in its first two years,” CHA spokesperson Cara Welch wrote in an email.
CHA has observed an increase in charity care among its members since 2019, driven by patients losing Medicaid coverage and the implementation of the discounted care law.
CCHI recommended that the Department of Health Care Policy and Financing create a standardized webpage template for discounted care information and use its audit to enforce website compliance. It also recommended that hospitals take further advantage of the department’s training about discounted care so hospital representatives convey complete and correct information to patients.
A new online price finder released last month helps Colorado patients compare procedure prices across hospital systems.
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