Critics assail UNMH surgery policy - Albuquerque Journal

Critics assail UNMH surgery policy

Copyright © 2017 Albuquerque Journal

Community health advocates contend that University of New Mexico Hospital has changed its policy and is requiring uninsured, low-income patients to pay 50 percent in advance for non-emergency surgery.

But UNMH officials respond that no one is denied medically needed non-emergency surgery. The hospital defers the 50 percent down payment if doctors deem the surgery “medically urgent” under a policy that has remained unchanged for years.

“We will not allow economic conditions to have a negative effect on the health of our patients,” said Billy Sparks, spokesman for UNMH.

About 20 advocates in late June jammed a committee room to urge members of the UNMH Board of Trustees to rescind what they described as an abrupt policy change and allow uninsured patients to obtain needed surgeries without delay.

Trustees responded by asking administrators to review the hospital’s billing process and report their recommendations at the board’s meeting later this month.

Dr. Anjali Taneja, a physician at Casa de Salud, a South Valley clinic that serves immigrants and other low-income patients, said patients she refers to UNMH have reported a change in recent months.

“At this point, it feels like a policy that came completely out of nowhere,” Taneja told UNMH trustees.

Patients have told her that they can’t obtain a medical procedure at UNMH because they can’t afford to pay 50 percent of the cost in advance, she said.

“That’s where it stops for them unless they have a sophisticated advocate,” Taneja said after the meeting.

Advocates say the practice has had the effect of creating new barriers for uninsured patients, requiring them to follow a complex appeals process to get treatment.

“The hospital shouldn’t be charging indigent patients a 50 percent down up-front charge for medical care,” said Sireeshe Manne, an attorney with the New Mexico Center on Law and Poverty.

The disagreement centers on “finance guidelines for surgical cases” issued by UNMH in May that advocates say altered a 2015 policy by eliminating affordable co-payments for uninsured patients with incomes low enough to qualify for the hospital’s discount program.

UNMH officials said they issued the guidelines in May because insurance companies were refusing to pay for surgeries that had not been pre-approved, resulting in last-minute cancellations of surgeries. In some cases, patients were denied coverage for surgeries, UNMH said in a written statement.

The guidelines require all patients to receive approval by a UNMH financial consultant before they are scheduled for surgery, the statement said.

“We do not believe these guidelines have impacted low income self-pay patients access to care,” the statement said. “To the contrary, the number of procedures for this group has increased.”

UNMH was unable to provide data about the number of indigent, uninsured patients who receive non-emergency surgery.

Examples of non-emergency surgery can range from cataract surgery to those that treat cancer and vascular diseases.

UNMH requires uninsured patients to pay 50 percent in advance for surgery and other procedures “not deemed medically necessary and determined to be purely elective by our medical staff,” the statement said.

But May 2 guidelines list a “medical-urgency exception” that allows UNMH to defer the 50 percent down payment if doctors consider the surgery medically urgent.

“Patients need to be cleared financially, and, in appropriate cases, cleared for medical urgency” before surgery is scheduled, according to the guidelines.

Manne said the guidelines require indigent patients “to go through a huge bureaucratic process to get care,” leading to delays and cancellations of needed surgeries.

Dr. Irene Agostini, UNMH’s chief medical officer, said the medical-urgency exemption ensures that patients in medical need can get surgery without paying the 50 percent down payment. The decision to defer the down payment is made by Agostini and the treating physician, she said.

“Our goal was not to put barriers up,” Agostini said after the meeting. “We have no intention of delaying patients’ surgeries for socio-economic reasons.”

The hospital’s 2015 payment policy remains in effect today, UNMH CEO Steve McKernan wrote in a memorandum in response to the criticism. The new guidelines issued in May are intended “to provide greater patient access to surgical procedures,” he wrote.

“One area of concern has been scheduling surgical procedures that then have to be rescheduled due to a patient’s subsequent inability to make the Patient Payment Policy’s required 50 percent down payment,” McKernan wrote. “This is seen as disruptive to the operation of the operating rooms, unfair to other patients, and a less than optimal allocation of resources.”

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