On August 6, the Los Angeles County Board of Supervisors passed an ordinance that will require hospitals to inform the county’s Department of Public Health (DPH) of attempts to collect medical debt from patients.
HASC is actively engaging with DPH to discuss all ordinance elements, including data reporting requirements. We aim to gain clarity, express concerns and suggest necessary amendments. Throughout this process, HASC is convening revenue cycle teams from affected member hospitals, providing a platform for their feedback. We then relay this feedback to the DPH during our weekly meetings.
Gains
HASC has made significant progress in mitigating some of the ordinance’s burdensome and unreasonable components. For example, we successfully lengthened the trigger for the period and frequency of reporting to DPH. We’ve also eliminated overly taxing data elements, along with mandatory ones. Instead, hospitals will provide all data points only “if available.” DPH has included an opportunity for reassessment of their program and evaluation by the Board.
Another important change was removing DPH’s proposal to create publicly available scorecards based on their evaluation of individual hospitals’ financial assistance policies. DPH has abandoned that plan and instead created a committee to review best practices to provide to all hospitals.
Background
Hospitals and health systems are deeply concerned about medical debt, as the only sector providing 24/7 health care regardless of patients’ ability to pay. Hospitals support this commitment by offering financial assistance and helping patients qualify for programs like Medicaid and Covered California. In 2020, hospitals provided over $42 billion in uncompensated care nationwide. These costs result from both inadequate payment from public payors such as Medicare and Medicaid and caring for uninsured patients.
Hospitals advocate for comprehensive coverage for all and continue absorbing significant financial losses to care for those who can’t pay. Despite these efforts, gaps in health care coverage like high deductibles expose patients to unaffordable costs, highlighting the limitations of current insurance programs.
HASC supports reasonable debt activity data collection that isn’t overly taxing. We also aim to ensure data collection remains manageable and doesn’t expose member hospitals to data breach vulnerabilities or violate HIPAA regulations.
We also believe that any data collected must be actionable. Data collection for its own sake doesn’t serve the intended purpose and adds unnecessary complexity and risk. HASC is requesting a reassessment of the data collection efforts after a specified period. We seek a commitment from DPH to review and modify these mandates if they are found to be ineffective or too burdensome.
Medical debt nationwide
While this ordinance is specific to unincorporated Los Angeles County, the issue of medical debt is widespread and continues making headlines across the country. For that reason, HASC continually monitors local governments to mitigate negative impacts of similar ordinances elsewhere.
HASC also continues challenging the narrative that hospitals are wholly responsible for medical debt. Non-hospital providers, health plans and insurance companies also have a role to play in creating solutions to medical debt. As such, we continue asking the county to incorporate these stakeholders into collaborative dialogue, rather than maintain its current sole focus on hospitals.
We will keep you informed of new developments with this ordinance and all issues related to medical debt. As always, please don’t hesitate to reach out to me or HASC staff with any questions or concerns.
Take care and stay safe.
George G.