ACCESS

Shopping for Deals

California introduced a website January 25 that will help consumers find out how much hospitals are willing to discount care for uninsured patients. The site makes California the second state, after New York, to give consumers a tool to compare prices or discount payment policies at nonprofit hospitals. Hospitals have been criticized in recent years for being overly aggressive in trying to collect payments from patients, many of whom are uninsured. The Hospital Fair Pricing Program site stems from a 2006 California law that prohibits the state’s hospitals from charging moderate- to low-income patients—those who earn up to 350 percent of the federal poverty level (FPL)—more than the highest rates charged by Medicare or any other government program in which the hospital participates. On the site, consumers can search a hospital by name or location to find the hospital’s discount pricing policy, determine the income levels that qualify for discounts and download applications to participate. Policies vary among hospitals, but patients who are uninsured or have inadequate coverage can qualify for low-priced or free care if they earn less than 350 percent of the FPL, or if their medical costs exceed 10 percent of their annual family income. The site also lists a number of hospitals that offer discounts to patients earning up to 500 percent of the FPL. So far, policies for 82 percent of California’s 405 acute-care hospitals have been posted.

Clinic, Heal Thyself

CheckUps, a New York company providing health clinics in retail settings, announced January 18 that it plans to close 23 clinics operating in Wal-Mart Stores in Florida, Louisiana, Alabama and Mississippi because of an inability to make payments to nurses and other vendors. CheckUps ended payments to some nurses in December 2007 and owes $108,000 to Med Tracker Personnel, an employment agency that provided nurses to the clinics. Wal-Mart has leased space to about 80 clinics in stores across the country, all of which are operated by independent firms. While some of the Wal-Mart clinics are headed by doctors, most are run by nurse practitioners who are limited to providing routine medical care like giving flu shots or prescribing drugs for sore throats. Operators say their main clients are mothers with small children, and that about 30 percent do not have a family doctor. Wal-Mart said it hoped the CheckUps clinics would not stay vacant for long. “We are working to reopen the clinics as quickly as possible,” Deisha Galberth, a Wal-Mart spokeswoman told the New York Times. Galberth said Wal-Mart was proceeding with plans to lease space for several hundred clinics in the next two years, and expanding to as many as 2,000 clinics by 2014.

MEDICAID

Premature Babies Not Getting Follow-Up

Infants born weighing less than 3 pounds are particularly vulnerable to vision, hearing and speech impairments. But a new study of more than 2,000 very low birth-weight babies in Medicaid found that less than one-quarter received follow-up care for those conditions. Study investigators reviewed the records of 2,182 children born in South Carolina between 1996 and 1998, focusing on how hearing and vision loss were managed after the babies were discharged. Only 20 percent of infants who could benefit from hearing rehabilitation services received them by 6 months of age, and only 23 percent received routine vision exams between ages 1 and 2, according to the study, which will be published in the February issue of Pediatrics. “This study shows just how badly these vulnerable babies are falling through the cracks of our health care system,” says lead study author Jason Wang, a Robert Wood Johnson physician faculty scholar. “We spend about $250,000 on each of these babies while they are in the hospital to make sure they survive the NICU…the least we can do is guarantee them the resources and attention they need so they can hear and see when they go home.” Hospitals should make efforts to improve the coordination of the complex care that these babies require once they leave the hospital, he added. “Very low birth-weight babies go home with multiple health problems,” says Wang. “It’s often too much for parents and one pediatrician to manage. Families need a support team to ensure that their babies get the care they need through early childhood.” Nearly 60,000 very low birth-weight babies are born in the United States every year.