Close readers of the Health Policy Hub will note that most of our blogs on hospital issues tend to sound a common refrain: transparency, transparency, transparency. If what’s coming over our wires is any indication, transparency—or the lack thereof—about hospital pricing, financial assistance, and bill collection is resonating these days in many corners of the country.

Why? Why does transparency matter so much—and why is it so hard to come by?

Let’s look at the story that played out in New York last week. Last Monday’s New York Times covered a major report by our partners at the Community Service Society of New York (CSSNY) that investigated how hospitals receiving $1.2 billion in public subsidies from the state’s Indigent Care Pool handle bills for low- and middle-income patients. The findings were alarming: many New York hospitals are using Pool funds to write off patient “bad debt.” Hospitals that tag patient accounts as “bad debt” can, and often will, send the accounts to collections—a decision that can have long-term financial implications for patients. For example, New York hospitals receiving $250 million in Pool funds had collectively placed 4,000 liens on patients’ homes in 2010 in attempts to collect on bad debt. Furthermore, many New York hospitals are falling short of state requirements that they inform patients about financial assistance and other programs before collecting on outstanding bills. Yet, public funds have continued to flow to hospitals flouting these rules.

While New York hospitals may not be feeling the impact of these practices, their patients certainly are. Hope Rubel, a self-described “typical middle-class American,” found herself on the wrong side of one New York hospital’s accounting ledger. Uninsured due to prohibitively high costs, she received emergency hospital services after a stroke—closely followed by an $88,000 hospital bill she couldn’t afford. On Wednesday, Ms. Rubel (along with CSSNY and Community Catalyst staff) talked about her experience with Democracy Now! hosts Amy Goodman and Nermeen Shaikh.

AMY GOODMAN: Did you understand you could get some kind of financial aid?

HOPE RUBEL: No, absolutely not. […] I had one brief conversation with a social worker while I was in the hospital that was fruitless for me, and then I was on my own. And then the bills started coming from the hospital, and then the phone calls, and then a collection agency, and then the lawyer. I spoke with the lawyers, and I explained to them my situation and that I did not have the money to pay this bill. And they said that we could work out a monthly payment of about $2,000 a month—would be, you know good—

AMY GOODMAN: To the hospital. […] For how many years?

HOPE RUBEL: —an $88,000—well, ’til the $88,000 was paid off. I said, “Well, I am in no position to pay that kind of money. I cannot do it. I don’t know what to tell you. I can’t do it.” Then the paperwork came: they were suing me.

This is why consumer advocates stress the importance of hospital transparency. Far too often, the burden of navigating the complex maze of hospital pricing, or of asking the right questions about financial assistance or a fair payment plan, falls to patients who do not know such programs exist. For these patients, any miscommunication or misstep carries long-term financial consequences with little possibility for relief. And if this happens in New York—where, it bears noting, the laws around hospital transparency are comparatively robust—consider the burden that falls on patients in states without any such laws at all.

The policy solutions to the problem are pretty simple, actually, but they’re all rooted in one thing: transparency. We need hospitals to provide patients and the public with information about financial assistance and billing programs. We need policymakers to gather and share this data in a way that enables comparisons of hospitals’ policies. That’s how we’ll know where the trouble spots are.

Yet some hospital groups are adamant that things are working fine the way they are, thankyouverymuch. But for whom? When trade associations block national initiatives to make information about financial assistance programs publicly available, or frame Coloradans’ efforts to limit charges to low-income uninsured patients as “unnecessary administrative requirements, which would in turn increase the cost of health care and impede access,” we have to wonder who they’ve been talking to.

Because it certainly isn’t Hope Rubel, or the millions of Americans who are in her shoes.

If it were, hospitals would be singing a different tune.

 — Jessica Curtis, Director Hospital Accountability Project