HCA announces it will waive trauma fees for the uninsured in Florida

Herald/Times Tallahassee BureauApril 10, 2014 

Hospital Corporation of America, Florida’s largest provider of trauma care, announced this week it will stop charging uninsured patients a special trauma fee that can add $30,000 or more to their bills.

The new policy, announced Tuesday to the News Service of Florida, comes one month after the Tampa Bay Times published the results of a yearlong investigation showing that hospitals across the state were charging huge fees to trauma patients even when they needed little more than first aid.

The fees work like a cover charge and come in addition to charges for medical procedures. The Times found that HCA’s fees were by far the highest in the state, averaging $27,644 in the first half of last year compared to $6,754 at other hospitals in the state.

Even so, waiving the trauma fees for uninsured HCA patients may have little impact. Hospitals generally collect only a portion of what they bill patients. And the amount collected from uninsured patients — compared to those covered by auto or health insurance policies — can be tiny.

HCA officials told the Times last month that their hospitals collect less than $300 on average from uninsured patients.

HCA’s announcement comes at a critical time for the for-profit hospital chain, which includes Blake Medical Center in Bradenton.

State legislators are weighing bills that could decide a debate crucial to HCA’s unprecedented expansion into trauma in Florida.

The bills being considered would grant HCA the right to keep three trauma centers, including one at Blake, open regardless of the outcome of court cases seeking to shut them down.

After the Times investigation, the Senate tacked on measures to one of the bills that would curb the fee and promote pricing transparency. The House is now considering doing the same to its HCA legislation.

Thursday, the Senate will consider legislation to cap the fee at $15,000 for a year and convene an advisory council to study fees and make long-term recommendations.

Also Thursday, the House will consider legislation to implement a similar $15,000 cap and require hospitals post their trauma fee prices inside their trauma centers and on their websites.

HCA officials did not respond to questions from the Times about its new policy.

It is unclear whether the discount will apply to car crash victims whose only coverage is from auto insurance.

It is also unclear whether it will apply at HCA trauma centers outside of Florida.

In 2012, an HCA trauma center in Nevada charged hospitalized patients an average trauma fee of $21,227. And last year in California, one HCA center’s price list included trauma fees as high as $30,662.

Pat Palmer, a health care consultant who analyzes patient charges for Medical Billing Advocates of America, says HCA’s new policy gives her “great concern.”

“Why are we discriminating against people that are not uninsured?” she asked. “There are a lot of under-insured, who have high deductibles, and they’re responsible for these amounts.”

Since 2012, HCA’s Florida trauma centers have charged at least $26 million in trauma fees to more than 900 uninsured patients, according to data reported to the state Agency for Health Care Administration.

One in six of the HCA patients charged trauma fees was uninsured.

Meanwhile, HCA has charged at least $70 million in trauma fees to more than 2,400 patients with commercial insurance — almost half of all patients charged the fee.

It is impossible to know how much uninsured patients actually wound up paying because hospitals are not required to publicly report such numbers.

Tony Carvalho, president of the Safety Net Hospital Alliance, said the corporation’s move “is nice,” but said HCA probably is collecting little if any money from its uninsured trauma patients.

Speaking for the alliance, which represents Florida trauma centers involved in lawsuits to shut down HCA trauma centers, Carvalho said, “There should be protections from price gouging for all patients.”

HCA attorney Steve Ecenia told the News Service of Florida that the company’s new policy to waive fees for the uninsured is not related to the Times’ reporting, but that company officials have been looking at the issue for “quite a while.”

Yet in numerous communications during the Times’ yearlong investigation, HCA officials did not mention the potential for waiving trauma response fees for all uninsured patients.

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