by Nick Jacobs

My first health care administration job began in 1988. It was a warm September morning when we met around a large table to examine the financial report of the hospital. The CFO reported out the income from operations, and, although I was new to this particular field, it struck me that all we were looking at was the inpatient report. When I asked where the outpatient information was, he replied, "Oh, we don't have any way of capturing that information." To which I asked, "Isn't that at least 50% of our business?" The answer of course was positive. It was at that very moment that the history of health care management came crashing in on me. Not unlike a University, if the money didn't balance, you just raised the tuition, or, in our case, the costs. Many refer to that time as the "good ole days."

This week, the Wall Street Journal had a blockbuster article that should have been entitled, "Dah." It was about the new wave in hospitals to collect cash upon registration for deductible insurance costs. It was entitled Hospitals Demand Cash Upfront from Patients. It's a revolutionary new idea in hospital billing where hospitals actually are making medical care contingent upon up front payments. At least that is how the WSJ depicted it.

In my world, it does not seem quite that drastic. Hospitals are just trying to collect those payments that seem sometimes rarely to be collectible. We do not deny access based on their ability to pay.

Clearly, bad debt is becoming more of a problem for us each and every day, and this is just one very late attempt to function like a business.

We need help, and, not unlike physician offices, why is it wrong to ask for co-payments as the patient enters? Your comments are welcome.