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Volume 60
Number 10
December 2009


Without Charge
Hopkins gives away millions in charity care. Patients just need to apply.

blank Nelson Haller
Nelson Haller faces a month’s worth of financial assistance applications from Hopkins Hospital.

Reporting the amount of free care that hospitals give to patients has been optional for health systems—until 2010. That’s when disclosing that total will become mandatory if a hospital expects to keep its tax-exempt status. It’s just one of several issues that is putting charity care in the national spotlight.

Of course, “Hopkins was founded for care of the indigent. I don’t know if people realize that,” says Nelson Haller, one of four directors of patient financial services for Johns Hopkins Medicine. “So, financial assistance isn’t new to us. In the 40 years I’ve been here in billing, we’ve done it every year.”

Haller’s department, which houses more than 300 people and is located in the Alpha Commons Building at Johns Hopkins Bayview Medical Center, does the billing for Hopkins Hospital, Bayview and Howard County General Hospital. In FY09, according to audited financial statements, Hopkins gave $37 million to charity; Bayview gave $28.3 million and Howard County was at $1.7 million. Although hospitals are not required to provide a specific amount of financial assistance, there is talk of implementing legislation to establish an actual required amount.

Ironically, giving away charity care can be a dilemma for hospitals because patients don’t always cooperate. If patients are without insurance or Medicaid, which financial coordinators explore first, hospitals look into getting financial assistance for them. Although there is a standardized application in Maryland that requires patients to provide copies of income tax forms, pay stubs and savings accounts (family size is taken into consideration, too), getting families to submit this paperwork can be arduous.

Of the applications that Hopkins Hospital receives, “about 72 percent of the cases get approved,” says Haller. A determination is made within two days. The rest are denied “mostly because [patients] fail to complete the statewide application.”

On average, Hopkins gets about 50 applications a month, but there are more than double that number at Bayview because its “payer mix consists of needier patients,” says Haller.

Patients, however, don’t only receive bills from the hospital. Physicians bill, too, and the billing arm for faculty is called the Clinical Practice Association.

“Although we’re not obligated to give the same type of charity care, we do follow the same policy that the hospital follows,” says Donna Torbit, director of core services operations for the CPA. “If the hospital determines that a patient is eligible for charity care, they forward the information to us and we look at our accounts as well.”

Physicians have their reasons for seeing self-pay patients. “Because of continuity of care or special considerations that meet their research missions, physicians want to see these patients,” says Joyce Slater, senior director of revenue operations for the CPA. “The other scenario is the majority of our self-pay comes from patients coming through the emergency department with no insurance.”

Despite its good intentions, however, the CPA depends on the follow-through of self-pay patients to give out charity care. “Oftentimes, the patients don’t return the [financial assistance] documents to determine whether or not they’re eligible for any type of write-off,” says Torbit. “We have a financial assistance program, but few apply.”

On May 1, offering free care became less complicated, at least for the patients at the East Baltimore Medical Center. A new program, called The Access Partnership, provides specialty care to patients in five ZIP codes near Hopkins Hospital and Bayview.

“The physicians have all bought into the program,” says cardiac surgeon William Baumgartner, president of the CPA and chair of the committee of physicians, administrators and medical students that led to the program’s creation. “Their services are free.”

So far, more than 80 patients from East Baltimore have been referred for specialty care, primarily for radiology, cardiology and ophthalmology.

In addition to providing specialty care, another goal is to create a database of patients’ emergency department use before and after TAP. “There are two points to the program,” says Baumgartner. “First is to provide access and quality care, and the other is to reduce the number of admissions to the ED.”

He continues that the program “has everything to do with Johns Hopkins’ will. It is exactly what he wanted us to do. It’s not that it wasn’t being done. It just wasn’t being done in a comprehensive way.”

Haller says that there’s a simple message for patients regarding charity care. “Patients, work with us, because our biggest issue is that patients fail to reach out to us,” he says. “But we are more than willing to work with patients.”

–Mary Ellen Miller



Johns Hopkins Medicine

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