\n\tNoam N. Levey<\/span><\/p>\n

ROCHESTER, N.Y. \u2014 Jolynn Mungenast spends her days looking for ways to help people pay their hospital bills.<\/p>\n

Working out of a warehouse-like building in a scruffy corner of this former industrial town, Mungenast gently walks patients through health insurance options, financial aid, and payment plans. Most want to pay, said Mungenast, a financial counselor at Rochester Regional Health. Very often, they simply can\u2019t.<\/p>\n

\u201cThey\u2019re scared. They\u2019re nervous. They\u2019re upset,\u201d said Mungenast, who on one recent call worked with an older patient to settle a $143 bill. \u201cThey do think \u2018I don\u2019t want this to affect my credit rating. I don\u2019t want you to come take my house.\u2019\u201d<\/p>\n

At Rochester Regional Health, that won\u2019t happen. The nonprofit system in upstate New York is one of only a few nationally that bar all aggressive collection activities. Patients who don\u2019t pay won\u2019t be taken to court. Their wages won\u2019t be garnished. They won\u2019t end up with liens on their homes or be denied care. And unpaid bills won\u2019t sink their credit scores.<\/p>\n

American hospital officials often insist that lawsuits and other aggressive collections, though unsavory, are necessary to protect health systems\u2019 finances and deter freeloading.<\/p>\n

But at Rochester Regional, ditching these collection tactics hasn\u2019t hurt the bottom line, said Jennifer Eslinger, chief operating officer. The system has even been able to move staff out of its collections department as it spends less to go after patients who haven\u2019t paid.<\/p>\n

Eslinger said there\u2019s been another benefit to the change: rebuilding trust with patients.<\/p>\n

\u201cWe think and talk a lot and strategize a lot about where is the distrust in health care,\u201d she said. \u201cWe have to remove that as a barrier to meaningful health care. We have to get the trust with the populations that we serve so that they can get the care that they need.\u201d<\/p>\n

\u2018Folks Cannot Afford This\u2019<\/strong><\/p>\n

Rochester Regional, a large health system serving a wide swath of communities along the south shore of Lake Ontario, is big, with more than $3 billion in annual revenue.<\/p>\n

But in a place where once-mighty employers like Kodak and Xerox have withered, finances can be challenging. In 2022, Rochester Regional finished nearly $200 million in the red.<\/p>\n

Patients have their own challenges. Unable to afford their bills, many ended up in collections, or even on the receiving end of lawsuits. \u201cWe would go to court,\u201d acknowledged Lisa Poworoznek, head of financial counseling at Rochester Regional.<\/p>\n

Then, before the pandemic, hospital leaders looked more closely at why patients weren\u2019t paying.<\/p>\n

The barriers became clear, Poworoznek said: confusing insurance plans, high deductibles, and inadequate savings. \u201cThere are so many different situations that patients have,\u201d she said. \u201cIt\u2019s really just not as simple as demanding payment and then filing legal action.\u201d<\/p>\n

Nationally, nearly half of adults are unable to cover a $500 medical bill without going into debt, a 2022 KFF poll<\/a> found. At the same time, the average annual deductible for a single worker with job-based coverage now tops $1,500<\/a>.<\/p>\n

Instead of chasing people who didn\u2019t pay \u2014 a costly process that often yields meager returns \u00a0\u2014 Rochester Regional resolved to find ways to get patients to settle bills before collections started.<\/p>\n

The health system undertook new efforts to enroll people in health insurance. New York has among the most robust safety-net systems in the country.<\/p>\n

Rochester Regional also bolstered its financial assistance program, making it easier for low-income patients to access free or discounted care.<\/p>\n

At many hospitals, applying for aid is complicated \u2014 long applications that demand extensive information about patients\u2019 income and assets, including cars, retirement accounts, and property, KFF Health News has found. Patients applying for aid at Rochester Regional are asked to disclose only their income.<\/p>\n

Finally, the health system looked for ways to get more people on payment plans so they could pay off big bills over a year or two. Importantly, the payment plans are interest-free.<\/p>\n

That was a change. Rochester Regional, like some other major health systems across the country such as Atrium Health, used to rely on financing companies<\/a> that charged interest, which could add thousands of dollars to patients\u2019 debts.<\/p>\n

\u201cFolks cannot afford this,\u201d Poworoznek said.<\/p>\n

Ending \u2018Extraordinary Collection Actions\u2019<\/strong><\/p>\n

Working more closely with patients on their bills allowed Rochester Regional to stop taking them to court.<\/p>\n

The health system also stopped reporting people to credit bureaus, a practice many medical providers use that can depress consumers\u2019 credit scores, making it harder to rent an apartment, get a car loan, or even get a job.<\/p>\n

In 2020, Rochester Regional adopted a written policy barring all aggressive collections by the system or its contracted collection agencies.<\/p>\n