Interview With Director of Patient

Interview With Director of Patient Financial Services

An important issue in American health care, and in the current presidential race, is the large numbers of people who do not have health insurance. Without health insurance, people are reluctant to seek the care they need to stay healthy. To better understand the availability of services to people with and without health insurance, the following interview was conducted with a former director of patient financial services. The person interviewed, was employed at a corporate health care inpatient facility, reporting directly to the hospital's CFO, and indirectly to the CEO, and with reporting lines to the corporate business office director and the corporate CFO. While the person interviewed requested anonymity, he spoke openly and frankly about the health insurance and the idea of socialized medicine in America. The following is the interview is essay is based on that interview.

How has health care delivery changed over the last five (5) years and how do you think it will it change in the next five (5) years?

A worked in health care for twenty years. The first ten years as a business office staff person. My responsibilities were to verify insurance benefits and eligibility, bill the insurance, or Medicare or Medicaid, and to work with the account guarantor to satisfy any uninsured balance on the bill. That process still goes on today, but it is a process that has changed dramatically over the years. Years ago, we used to see people with good group health plans. It was not unusual to find plans where there were very low deductibles, or none at all. Today, of course, you not only have deductibles, you have co-insurance, or patient pay shares. The financial burden on the patient receiving care today is much greater than the burden was years ago.

Of course the role of managed care has changed the delivery of services to patients over the years. Where patients once were admitted to the hospital as inpatients, had surgery, and stayed in the hospital until their surgeon or family doctor felt comfortable with their condition to discharge them. Now, of course, before seeing a family doctor, and especially before being admitted for inpatient care, an insured person must contact the health insurance for pre-approval. Then, once the patient is hospitalized, there is a lot of pressure put to bear on the physician to do what he has to do, and to send that patient home as quickly as possible. For certain health problems, we do not even see patients admitted for inpatient care anymore. Certain procedures and treatments are done strictly on an outpatient basis. So we have seen an increase in outpatient and clinic services, and a decrease - a drastic decrease in inpatient services and length of stays.

I would predict that we will continue to see that decrease and perhaps elimination altogether of inpatient care, except in the most emergency oriented cases and surgeries. Then, as soon as the procedure is done, I would anticipate that we will see people sent home, where visiting nurses will see them once or twice a week while they recover. It is a very serious direction that I see health care moving in. For all our modern technology, in many ways, it seems like we are regressing fast in the delivery of health care.

What are ways in which the hospital and its providers interact with the public health system?

That relationship is much more recognizable today than it was five years ago. As much as possible, we see hospitals moving patients in the direction of public health systems when they are uninsured, or when managed care refuses to allow them access to their benefits and treatment. We see many more people using the health clinic services that offer sliding scales based on income. People who have no insurance, or especially people suffering from mental and nervous conditions, are referred to the public health centers for follow-up care and treatments.

Do you believe there is adequate coordination between the public health system and the health care delivery system in general?

There is a greater coordination between the private health care providers and the public health systems these days because it is necessary. There is no other source for many patients who come through the private system to receive follow-up care other than the public health system. Where there was once virtually very little coordination between private and public systems, today we see extensive coordination because it is necessary. The cuts in Medicaid, and the loss of group health benefits has necessitated a more coordinated effort.

Is there a health care delivery preparedness plan for a public health event, such as an infectious epidemic or bioterrorist attack?

Private hospitals have plans, and go over and test those plans on a periodic basis as is required by oversight. However, after Hurricane Katrina it is difficult to imagine how those plans would unfold. Those hospitals that were forced to abandon patients and staff were required by law to have those kinds of plans, and, in my opinion, they failed. So we have plans, but let's hope we would never have to test them, because the day-to-day operations as dictated by the delivery of health care is really not conducive to carrying out those plans. Either of those events that you mentioned would really spell disaster for a hospital. The atmosphere in hospitals today, with specialists and without the staff that is actually employed by a hospital to make that loyalty connection, has turned the hospital environment into a kind of every man for himself environment.

Follow-Up

Researching the director's remarks, concurring remarks to his are found in the 1997 book authored by Arnold Birenbaum, Managed Care: Mad in America. Birenbaum makes very similar remarks about health care before, and after managed care (p. 1). The language, or rhetoric, used by professionals writing on the subject raises concerns about the direction of health care and the delivery of services consistent with maintaining and improving the quality of life.