Majority of debtors to US hospitals now people with health insurance

Jessica Glenza

The Guardian

Originally posted 11 Jan 24

People with health insurance may now represent the majority of debtors American hospitals struggle to collect from, according to medical billing analysts.

This marks a sea change from just a few years ago, when people with health insurance represented only about one in 10 bills hospitals considered “bad debt”, analysts said.

“We always used to consider bad debt, especially bad debt write-offs from a hospital perspective, those [patients] that have the ability to pay but don’t,” said Colleen Hall, senior vice-president for Kodiak Solutions, a billing, accounting and consulting firm that works closely with hospitals and performed the analysis.

“Now, it’s not as if these patients across the board are even able to pay, because [out-of-pocket costs are] such an astronomical amount related to what their general income might be.”

Although “bad debt” can be a controversial metric in its own right, those who work in the hospital billing industry say it shows how complex health insurance products with large out-of-pocket costs have proliferated.

“What we noticed was a breaking point right around the 2018-2019 timeframe,” said Matt Szaflarski, director of revenue cycle intelligence at Kodiak Solutions. The trend has since stabilized, but remains at more than half of all “bad debt”.

In 2018, just 11.1% of hospitals’ bad debt came from insured “self-pay” accounts, or from patients whose insurance required out-of-pocket payments, according to Kodiak. By 2022, the proportion who did (or could) not pay their bills soared to 57.6% of all hospitals’ bad debt.

The info is here.

The US Healthcare system needs to be fixed:

Not all health insurance plans are created equal. Many plans have narrow networks and limited coverage, leaving patients responsible for costs associated with out-of-network providers or specialized care. This can be particularly detrimental for people with chronic conditions or those requiring emergency care.

Medical debt can have a devastating impact on individuals and families. It can lead to financial hardship, delayed or foregone care, damage to credit scores, and even bankruptcy. This can have long-term consequences for physical and mental health, employment opportunities, and overall well-being.

Fixing the US healthcare system is a complex challenge, but it is essential to ensure that everyone has access to affordable, quality healthcare without fear of financial ruin. 

New Jersey Psychology Practice Revealed Patients’ Mental Disorders in Debt Lawsuits

By Charles Ornstein
ProPublica, Dec. 23, 2015

When a New Jersey lawyer named Philip received legal papers last year informing him that his former psychologist’s practice was suing him over an unpaid bill, he was initially upset they could not work out a payment arrangement outside of court.

It was only later, Philip said in an interview, that he scanned the papers again and realized something else: The psychology group to which he’d confided his innermost feelings had included his mental health diagnosis and treatments he received in publicly filed court documents.

The greatest fear of many patients receiving therapy services is that somehow the details of their private struggles will be revealed publicly. Philip, who requested his last name not be used to protect his privacy, said he felt “betrayed” by his psychologist. He worried that his legal adversaries would find the information and try to use it against him in court.

“It turned my life upside down,” he said.

The article is here.

Burnout, Dissatisfaction Seem Rampant Among Medical Residents

By Kathleen Doheny

HealthDay Reporter

Latest Mental Health News

MedicineNet.com

TUESDAY, Sept. 6 (HealthDay News) -- The medical resident of today -- possibly your doctor in the future -- is exhausted, emotionally spent and likely stressed out about debt, a new study indicates.

"About 50% of our trainees are burned out," said study leader Dr. Colin P. West, an associate professor of medicine and biostatistics at the Mayo Clinic in Rochester, Minn.

Higher levels of stress translated into lower scores on tests that gauge medical knowledge and more emotional detachment, among other fallout.

The study is published in the Sept. 7 issue of the Journal of the American Medical Association, a themed issue devoted to doctors' training.

West and his team evaluated results of surveys and exams given to nearly 17,000 internal medicine residents, who were said to represent about 75% of all U.S. internal medicine residents in the 2008-9 academic year. The participants included 7,743 graduates of U.S. medical schools. They were asked about quality of life, work-life balance, burnout and their educational debt.

Among the findings:

• Nearly 15% said their overall quality of life was "somewhat bad" or "as bad as it can be."
• One-third said they were somewhat or very dissatisfied with work-life balance.
• Forty-six percent said they were feeling emotionally exhausted at least once a week.
• Nearly 29% said they felt detached or unable to feel emotion at least once a week.
• More than half said they had at least one symptom of burnout.

 The more educational debt the residents had incurred, the greater their emotional distress, the researchers found. Those with more than $200,000 of debt had a 59% higher chance of reporting emotional exhaustion, 72% greater likelihood of suffering burnout, and an 80% higher chance of feeling depersonalization.

Perhaps more alarming is the finding that greater stress was associated with lower test scores, and those students who were academically hurt by stress never caught up with their peers.

West said he can't explain why those more laden with debt are more stressed out. One possibility is that they may be more prone to stress to begin with.

Medical residents' stress has made news for years, and efforts are under way to improve their working conditions. However, West said, "to our knowledge, this is the first national study of residents' distress issues. And it's also the first national study to connect those issues to other important outcomes like medical knowledge."

As for solutions, he said "we have not yet identified the best ways to reduce burnout and promote well-being for residents, or for physicians in general."

He hopes that this new data, now gathered nationally, will help lead to solutions.

The findings come as no surprise to Dr. Peter Cronholm, an assistant professor of family medicine and community health and also a senior fellow at the Center for Public Health Initiatives of the University of Pennsylvania.

Cronholm, who published a study on resident burnout in 2008, said the residents of today may put more emphasis on work-life balance than previous generations.

One disturbing finding, he said, is that a stressed-out resident has less empathy over time. Already, close to one-third said they felt detached emotionally at least weekly.

However, he said, it's difficult to balance obligations to patients and get sufficient sleep and personal time. "Those two things sort of continue to compete with each other," he said.

Solutions aren't available yet, as "the problem is not yet totally understood. This is part of the conversation about health care reform," he said.