More providers in LV Valley now billing in advance

Much of the local health-care industry seems loath to discuss billing practices, but those willing to talk about how hospitals get paid agreed that area operators are asking more often for money prior to treatment.

Just one major hospital chain and one trade group commented on local billing trends by press time. Several other area hospital operators, medical-clinic owners and even patient liaisons and advocates either didn't return calls or wouldn't talk on the record for this article.

Those who did speak to the Review-Journal said more local providers now bill in advance for some hospital care.

Ashlee Seymour, a spokeswoman for Sunrise Health, said the local hospital system's four acute-care centers are asking more frequently for both insured and uninsured patients to pay for nonemergency care before they provide treatment.

As employers and their insurance carriers switch patients to plans with big deductibles and high copays, the number of people unable to meet their obligations has jumped, Seymour said, and that's required a more proactive approach to collections.

Patients who visit emergency rooms inside Sunrise Health's four hospitals, which include MountainView, Sunrise, Sunrise Children's and Southern Hills hospitals, are not asked to pay prior to treatment, Seymour noted.

For patients going to Sunrise Health hospitals for nonemergency care, Sunrise Health determines before treatment whether they have insurance. Hospital representatives then call patients with insurance to discuss how they'll pay for the out-of-pocket portion of their bills. For the uninsured, Sunrise Health will check on eligibility through federal or state programs such as Medicaid, or through the company's charity programs. Uninsured patients who don't qualify for public assistance or charity get a discount on their care to help them pay.

"We work with patients to try to get them whatever assistance is available," Seymour said. "There is no blanket policy on how we (bill)."

Bill Welch, president and chief executive officer of the Nevada Hospital Association, said several factors are driving Nevada hospitals to increasingly seek payment before care.

First, the Silver State has a high rate of uninsured patients, Welch noted.

A 2004 study from the Robert Wood Johnson Foundation showed that 21 percent of Nevada's workers were uninsured. That proportion placed Nevada No. 6 in the nation for its share of workers without health insurance.

And the Great Basin Primary Care Association found that roughly 450,000 Nevadans, or 17.1 percent of the state's population, went at least a year without health insurance between 1998 and 2006.

Second, Nevada has a sizable contingent of insureds covered through national carriers with out-of-state headquarters, and those insurance companies don't always cover care through local providers, Welch said.

Add to those insurance issues a 2007 state law that reduced the time hospitals have to collect payments from six years to four years, and you have a hospital community preparing to scramble for ways to cover potential shortfalls.

"We have more uninsured patients showing up, a number of patients showing up whose insurers will not recognize the assignment of benefits and less time to collect on a bill," Welch said. "We are being pushed into a situation where we are going to have to be more diligent in trying to collect so costs are not shifted onto other folks."

About two-thirds of patients in Nevada already don't pay for the full cost of care they receive inside hospitals, and that's forcing up costs for the remainder of patients, Welch said.

"That's a challenge we have in trying to make sure there's some equity, and all are paying some portion of the care they're receiving," Welch said.

On top of tougher times collecting, hospitals grapple with thin profit margins, Welch added. The state's private hospitals, both for-profit and not-for-profit, averaged about 3 percent in profits in 2007, up from about 1.8 percent in 2006, Welch said. And from that net income, hospital operators must find the cash for expansions and new centers, he said.

"The environment is changing on us," Welch said. "The only way hospitals keep their doors open is through payment for the services they're providing. When was the last time a hospital wasn't expanding or under construction in Clark County? They have to pay for those improvements from their bottom line. That's how it's funded."

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512.