medical insurers that have already bargained rates with providers.
As part of their investigation, Reps. Billy Tauzin (R-La.) and
James Greenwood (R-Pa.) sent a letter last week to 20 hospital chains
nationwide, seeking information about how they bill their patients
and set their rates.
Of the 20 hospital chains, six are in California and two have
centers in Glendale. Glendale Adventist Medical Center is part of the
Roseville-based Adventist Health, and Glendale Memorial is part of
Catholic Healthcare West in San Francisco.
"We are not targeting a specific company, but we are targeting a
problem," said Ken Johnson, a spokesman for the House Energy and
Commerce Committee, adding that in some cases, it appears hospital
companies are overbilling the uninsured compared to health plans set
by other companies.
Officials have rapidly been trying to put together records to meet
the committee's July 31 deadline.
"I can't honestly see that it would have any effect," said Rita
Waterman, assistant vice president of corporate communications for
Adventist Health, referring to any local ramifications of the
inquiry. "At this point, we're assured this is nothing more than an
inquiry, that they're looking at the plight of the uninsured. We've
been told that a number of systems are being asked to supply quite a
bit of data."
Terry Lightfoot, spokesman for Catholic Healthcare West, said that
the information requested might not exist in the exact form the
lawmakers wanted because the tracking system is antiquated.
"We are currently reviewing the letter to determine how to provide
the information the committee has requested," Lightfoot said, adding
that ultimately, the company has supported some form of a universal
health-care plan to cover 40 million uninsured Americans.
Among the requested information in the letter are specific records
within each hospital's chain dating back to 1998. Requested
information includes net operating income, revenue collected per
patient per day under Medicare and Medicaid, revenue from uninsured
patients, cost-to-charge ratios and rate formulas.
The records wanted were for each hospital in the system, the
Lawmakers said so-called "self-pay" patients -- patients who have
no coverage through a third-party health plan and are not enrolled or
eligible for any government-sponsored program -- could be at
particular risk because providers increase costs to the uninsured to
make up for revenue lost in discounted plans to the insured. "These
rates are often inflated far beyond their actual costs and reasonable
profit due, in part, by the providers' need to make up for the steep
discounts from charge master prices demanded by the third-party
health plans," the letter said.