I'm not in hospital admin but work with them regularly including our chief medical officer, case managers, etc. Our hospital admin is literally down the hallway from our office. I work with them regularly. Maybe I'm naive. I worked in non-profit hospital systems and from my practice, I get paid regardless of anyone's ability to pay. As a consequence, I am privileged to provide the best care I know regardless of insurance or not. Sure, I have to justify my care, I have to do that anyway. Our system has spent millions in charity care a year. Can I speak to all hospital systems? No, I cannot. To be honest, I've worked for contracting group which was for-profit for a few years and vowed never to do that again.
My personal care is expensive. My medication, Benefix, literally costs $1000000 a year. I have to give myself an IV injection every 3 days. Add in the frequent hospitalizations for joint bleeding and pain control and I am considered a high utilizer. It would not take long for a hospital to boot me out if I couldn't pay. I already know I will never qualify to going to a rehab center. My meds are too expensive. I have to go to specialized centers because most hospitals don't carry my drug or its equivalent. Its too expensive. It sucks when I go out of town because an out of network bill could easily be >$15000. I blow through my $6000 deductible every year within the first 2 weeks of the year. I can't have long-term care insurance or most disability insurances because I don't qualify. I'm also a transgender intersex woman. I've literally had to relearn to walk about once every 2-3 years of my life. My life is literally fragile, but I keep going.
I don't like our healthcare insurance setup in this country. I think everyone should have access to healthcare regardless of their ability to pay and I practice that way. Believe me, there are some patients in the past I would love to discharge, but I still make sure they're well taken care of. These are the patients who have physically assaulted my staff and those who have sexually harassed me.
When a patient comes in without insurance, we try to set them up. If they can't, it's a simple application for charity care. We've taken care of people for months in the hospital knowing we wouldn't be reimbursed.
In answer to the other question, if there was a bad outcome as a consequence of being booted out of a hospital then the answer is "yes" they are very much liable for that outcome. I have to sign a discharge summary stating what happened and why in the hospital. I also have to state a clear directive of a safe and appropriate disposition. I sign my name dozens of times a day. I'm not sure what happens in all hospitals, but I will not work for one that doesn't care for patients appropriately.
BTW, that Baltimore case:
https://oig.hhs.gov/fraud/enforceme...es-case-involving-patient-dumping-allegation/ was an EMTALA violation. The HHS fine was small, but it would not surprise me if there was another settlement with the patient/patient's family
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