By ANDY RIDDELL, President and Chief Executive Officer CMH Regional Health System

“I’d like to get it, but what do you pay first? Do you pay the mortgage? Do you pay your child support? Do you pay your car insurance? Do you pay for your medicine?” - A recent quote in the New York Times from a frustrated consumer on the cost of health insurance.

If the individual quoted in this article has any hospital bills, it is not surprising that he failed to mention them. In this slow economy, charity care and bad debt incurred by hospitals continues to rise and could be even more significant locally over the next six months to a year, depending on the final outcome of the DHL-UPS deal.

A troubling perspective for those of us within the healthcare system is the number of individuals who refuse to complete and/or return paperwork that would qualify them for state or federal aide to help pay for their hospital care. Another disturbing trend we are seeing at CMH is people with insurance who do not pay deductibles or co-insurance which can add up to millions of dollars a year. We know individual circumstances are different and we do not refuse treatment to anyone based on an ability to pay. We are not advocating that anyone put off medical care because of current financial circumstances.

But we actually have repeat patients, with the ability to pay and/or significant outstanding balances with us, who refuse to talk dollars and cents with us because they think healthcare should be free. Unfortunately, this is not England or Massachusetts where universal health care has proven to be far from perfect.

What are the chances the next time you buy or lease a vehicle that you are going to drive off the lot before the dealer has your cash in hand or the money from your bank loan? Not going to happen.

How about if you tell your cable provider or telephone company that you may or may not pay them in the future for services being utilized now or in the past? Your service would be cut off immediately.

What if after that next fine dining experience, you headed for the back exit to avoid paying your bill? How many times do you think you would get away with that?

Yet more and more hospital patients seem to consider health care a service that does not have to be paid for at point of service if at all. Some consider it an entitlement that is addressed only after repeated pleas, and in some cases, never addressed. Unfortunately, we are not a bank, but one of the largest employers in the area with employees and bills who expect regular payments.

Although CMH has not implemented such policies, many hospitals across the country are requiring substantial upfront payments from patients with long-term, costly conditions such as cancer and heart disease that may be life-threatening but are not considered medical emergencies. Hospitals across the country effectively donate millions of dollars each year in terms of community benefit.

According to the latest complete figures available from the Ohio Hospital Association, CMH’s community benefit totaled more than $20 million in 2006. That figure is arrived at by adding the cost of Medicaid losses ($2.5 million), charity care ($5.1 million), Medicare losses ($5.8 million), and the value of employees’ volunteer community benefit activity ($2.9 million). Bad debt accounts for $3.6 million of that community benefit, bills that are written off for patients with the ability to pay who choose not to. Name one other Clinton County organization who gives that much back to the community and imagine the technology or services that could be purchased with that.

You have probably read before that the bad habits of shoplifters add dollars to your bills at the retail checkout counter. By comparison, patients who don’t pay their hospital bills instead impact the hospital’s ability to enhance service for the entire community and can add thousands of dollars annually to our own health premiums. CMH understands and lives up to its obligation to charity care, that portion of patient care services provided for which a third-party payer is not responsible and a patient has documented an inability to pay. Charity care does not include bad debt, contractual adjustments, or un-reimbursed costs, but may include coinsurance, deductibles, and non-covered services if the patient meets the hospital charity care eligibility criteria.

CMH is responsive to legitimate community needs with its free and reduced cost care for eligible patients through its formal policies for charity care. Unfortunately, many patients do not complete the necessary paperwork either because they are embarrassed, too lazy or other reasons, which mean these charges become bad debt. Many patients who do not qualify for free and reduced cost programs might be eligible for funds available through the CMH Foundation.

Compounding the problem across the country is that many uninsured or underinsured people seek even routine treatment in the emergency room, where hospitals are legally bound to treat them. Even though most are offered free or heavily discounted care with proper documentation, the vast majority don’t even pay their discounted bills. Even the insured that are expected to pay co-pays or deductibles at time of service routinely skip out without paying and never look back.

The collection philosophy at CMH is to collect the payment due in full. It is recognized that due to individual circumstances this is not always possible. When all avenues have been exhausted and payment in full is not possible, an agreement, with the debtor, to make regular payments is necessary.

Recovery of the debt should be within a reasonable amount of time because we are not a bank and we must also pay our bills in a timely fashion. That is not an unreasonable philosophy and one that consumers live with everyday when they buy a car, use a utility or go to a restaurant.