First and foremost, I want to express my sorrow for Ms. [Anne Catherine] Gibbons’ experience [recounted in the letter in this issue, “Insurance Issues Cloud Hospital Stay”] and apologize for not fully meeting her expectations. Mission Health strives to always offer an exceptional experience throughout the care process. We take this so seriously that we have incorporated it into our BIG(GER) Aim: to get every person to their desired outcome, first without harm, also without waste and always with an exceptional experience for each person, family and team member.
Second, I want to be crystal clear that we accept all patients regardless of their ability to pay. That is the essence of our critical safety-net role for our region. It is a Mission Health core value as a nonprofit, community-owned and -governed institution, and it influences everything that we do.
Finally, I want to emphasize just how strongly I share Ms. Gibbons’ concern regarding the unwanted, unnecessary and frankly inappropriate intrusion of payer regulations on the care environment. Sadly, what she experienced is a Medicare requirement that hospitals are forced to comply with even though we know it isn’t the best for patient care.
Medicare sets the payment policies and specific criteria for when a patient is deemed to be an “inpatient” or an “observation/outpatient” patient. The implications of being deemed “observation” are significant, including higher out-of-pocket payments and the inability (for that episode of care) to qualify for a nursing home stay. The simple truth is neither hospitals nor physicians determine this status — it is based solely upon Medicare rules. Even worse, Medicare hires “bounty hunters” (recovery audit contractors) who are incentivized financially to find “inpatients” who can be reclassified as “observation” to reduce the Medicare reimbursement paid to hospitals.
Because of the understandable aggravation associated with these impossible-to-understand rules that make little sense to patients and have big financial implications even while one is ill, Mission tries to provide information to patients along the way to avoid a very big, very nasty surprise later. Congress has now mandated that these conversations occur at specified timeframes throughout the patient stay along with a written explanation. This situation is extraordinarily frustrating, and we welcome and echo Ms. Gibbons’ call for widespread political engagement on this very important and inappropriate matter.
Although Mission Health has been named one of the Top 15 Health Systems in the nation in four of the past five years, has patient mortality rates more than 40 percent below the typical hospital and has overall patient experience scores in the top of the nation, we are not perfect; so I apologize again to Ms. Gibbons and thank her for her feedback that will help us improve.
— Dr. Ronald A. Paulus
President and CEO, Mission Health