UNM Hospital Shouldn't Charge the Poor 50% Upfront for Surgery


Co-authored by Michelle Melendez, Director of EleValle and Dr. Anjali Taneja, MD, MPH, Executive Director of Casa de Salud

University of New Mexico Hospital is the state’s largest public hospital and most important safety net. As such, UNMH is entrusted with significant local tax revenue each year to be there for our families when we need medical or mental health care and have no where else to go.

That’s why it was so shocking and alarming when we started hearing from our patients in June that their surgeries were being cancelled because they couldn’t come up with 50% upfront.

Essentially, UNMH is denying medically necessary care to uninsured, low-income county residents by holding them to an impossible standard that no one can meet.

What is most frustrating is that a large coalition of community health advocates had already dismantled this 50% upfront policy once before, in 2005, and replaced it with a policy allowing people to get the surgery they need for $25 upfront and make payment plans for the balance.

By accompanying our clients to their appointments, we learned that UNM Hospital had changed its policy beginning in February, instructing staff to give patients estimates of the total cost and demanding 50% upfront before the surgeries could be scheduled.

We got ahold of a new pre-surgery financial approval form intended solely for those people who have gone through a rigorous financial screening process at UNMH and who have proven they are living in poverty and do not qualify for any kind of assistance. This new form channels surgery patients with “urgent” medical needs to appeal to UNMH’s chief medical officer. It’s unclear how the patients or their doctors are supposed to know to ask for an appeal – it’s not a given and it is not publicized anywhere.

UNMH quietly made this change while it was actively involved in prolonged, closed-door negotiations with Bernalillo County, tribes, and Indian Health Services about how to use $96 million in property taxes that voters had approved in November to support indigent health care. This is the mill levy that we all voted to support for the next eight years.

The new 50% upfront policy was only discovered in June by well-trained community health workers whose jobs entail ensuring that patients apply for UNMH financial assistance or for a self-pay discount in advance of any surgery and that they make reasonable payment arrangements for the balance of their hospital bills – they know the UNMH policies well. We worry about the vast majority of patients who don’t have such advocates looking out for their best interests.

Reviving this policy has already hurt hardworking residents. Patients have had their surgeries cancelled for necessary cancer care, and for necessary surgical repair of multiple torn knee ligaments. One patient who was asked for $17,000 upfront was told that his surgery is medically necessary if he wants to walk again. He’s 43 and the father of three children and has been living in Bernalillo County and paying taxes for 18 years.

The 50% up front policy directly contradicts UNM Hospital’s stated financial policies and specifically targets one of the most vulnerable populations. It was created without input from or knowledge of the UNM Hospital Board of Trustees, medical providers, or the public it serves.

When we voiced our opposition in June, hospital leaders’ initial response was that they have to worry about what happens to healthcare nationally. After a few more denials and rationalizations, we were told that this change was an unintended consequence of a process to make the operating room more efficient and profitable. It stands to reason that any proposed policy changes should be judged by how they will affect patient health, and not just the hospital’s bottom line. It’s called Health Impact Analysis (HIA).

Whatever the genesis, our public hospital must inspire a response different from creating a two-tiered system where the most indigent have to pay 50% up front for surgery. This policy is inhumane and economically harmful to individuals and to us as taxpayers by driving people to use the ER to deal with pain, where they cannot be turned away.

If those reasons are not enough to change this policy immediately, consider that UNMH has seen a nearly 50% decrease in uncompensated care since the Affordable Care Act and Medicaid expansion, and has since amassed cash reserves of $230 million for a new hospital. It’s high time for UNMH to be transparent and accountable to the public for its role in our community's health.


Portions of this article were submitted as an op-ed to the Albuquerque Journal.


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