Hospitals are counting every penny these days, which has put them in a new uncomfortable role: collection agent.

More local medical centers are implementing tougher policies that encourage - in some cases require - patients to pay part, or all, of their share of medical bills at the time of service.

After implementing new fee collection policies, Abington Memorial went from less than $10,000 a month in patient fees to more than $300,000.

"Given downturn in economy, if we weren't doing this, we'd be much further behind," Abington Memorial's Chief Financial Officer Michael Walsh said.

Historically, hospitals were less concerned with unpaid patient fees because they accounted for such a small portion of revenues, hospital and health care officials said. Now many believe they are the fastest growing portion of their uncollected debt.

Nearly half of almost 1,300 U.S. health care providers, including hospitals, surveyed last month did not know the amount a patient would owe at the time they receive care, according to NaviNet, a healthcare communications network.

The likelihood a health care provider will collect the full amount of patient payment drops to less than 20 percent, after care is provided, according to the National Association of Healthcare Access Management.

Increasingly, though, cost-conscious employers are shifting more financial responsibility to employees in the form of larger premium shares, higher copays, coinsurance and deductibles. Among adults with employer-sponsored group health coverage, out-of-pocket spending increased 34 percent between 2004 and 2007, from $545 to $729, according to a recent Commonwealth Fund study.

Five years ago, local hospital officials say that emergency room insurance copays were in the $35 range - today $100 is typical. Some insurance plans charge $200 a day copay for hospital stays. Other plans with deductibles or coinsurance can result in patient fees in hundreds or thousands of dollars for tests and treatment.

Framing Expectations

Abington Memorial's Walsh acknowledged in the past the hospital wasn't aggressive about asking patients to pay their portion before they were discharged.

In 2007, Abington's point-of-service collection revenues totaled $1.2 million, about 10 percent of what was owed the hospital, said Betsy Seeber, director of patient accounts. Further data analysis revealed that six months after the date of patient service, the hospital collected only 60 percent of what patients owed in copays or other fees.

Full story