Maine program offers new option for paying hospital bill

When P. Jandreau signed up to be a volunteer at Franklin Memorial Hospital in Farmington, Maine, she had no idea that her service would ultimately help resolve a personal dilemma.

The 51-year-old Livermore Falls resident had sought the work to help strengthen her body, which was weakened by a lung problem. Little did she know that donating her time would lead to a means through which she could pay off her hospital bill.

Through her service, Jandreau stumbled upon Franklin Memorial's Contract for Care program, which allows patients who can't pay for the care they receive to work off their hospital bills by volunteering. She signed up right away.

"It took a load off my mind, and no one knew," said Jandreau. "This gives you a chance to maintain your dignity and give back to a worthwhile cause. It's a win-win situation."

The program, which is strictly voluntary and only available to those who meet certain criteria, has received a lot of attention since it was started seven years ago as the brainchild of CEO Rick Batt. Some observers have questioned whether it raises ethical issues, while others have touted it as a commonsense business tactic. To be sure, it is unusual.

Though some hospitals or doctors may offer alternative payment methods to their patients, Contract for Care is thought to be a one-of-a-kind program in its design, working in tandem with the hospital's traditional volunteer services.

It is offered as an alternative to patients who don't feel comfortable accepting charity care. To protect their privacy, they are treated as regular hospital volunteers.

"It's based on a smile and a handshake," said Jan Hannaford, director of volunteer services at the hospital. She said if a participant dropped out of the program, there wouldn't be any negative consequences.

Hannaford said the work is different for each participant, depending on individual skills. Some may be asked to do grounds work, others may be asked to serve as patient escorts or work in the mail room. "It goes from soup to nuts," she said.

No dollar amount is assigned to the work, but Hannaford tries to reach an arrangement so participants know how much work will be expected from them. Some may be asked for 25 hours of volunteering; others could be asked to put in 100 hours. It's decided on a case-by-case basis.

The program is available only to individuals whose income is between 100% and 200% of federal poverty guidelines, those who have limited or no health insurance and those who would otherwise be unable to pay their bills. Relatives and friends may volunteer on another person's behalf.

Some observers say the program is a savvy business tactic because it helps the hospital get extra work done for free. Indeed, Hannaford said one participant offered his skills as an auto body repairman to fix hospital vehicles, a service that would have cost money if it hadn't been donated.

But the hospital isn't in it for freebies, said Dan Marois, Franklin Memorial's marketing director. "Dollar for dollar it's probably not there for us. That's not the purpose. It's what the volunteer goes away with."

Rick Wade, senior vice president of the American Hospital Assn., said the program is well-suited to a rural hospital, where the community members may have a historical tradition of bartering for services.

He predicts that similar programs may take root as more hospitals struggle with bad debt. "Hospitals are writing off an enormous amount of bad debt. Some people might turn to this as an idea," he said. "It does brings something into the hospital."

Though the hospital benefits from the program, Wade said Contract for Care creates a good ethical situation for everyone. "I see the return of the ethic of people wanting to pay for what they get and not wanting to take something for nothing. It's also the hospital sending a signal back to the community that they value the people."

Priscilla Ray, MD, vice chair of AMA's Council on Ethical and Judicial Affairs, said it is up to the administrator of the hospital to decide if there is an ethical question raised by Contract for Care. But Dr. Ray said if a private physician was considering offering a similar program, he or she may want to be careful about how the offer is made.

For example, Dr. Ray said that if a physician tells patients who have already received care that they can work off their bills, it could be construed as soliciting a contribution from a patient. "What you've just done is said the agreed-on fee is none but now I want a gift from you," she said. "The emotional pressure on the patient is the question here."

Debi Davidson, 50, of Fayette, Maine, thought Contract for Care sound like a reasonable program when she decided to participate in it after her 10-year-old son was hospitalized for an asthma attack.

The hospital reduced its bill and paired Davidson, a wildlife biologist, with someone doing data entry for health studies. Working one day a week, Davidson expected to spend about 100 hours volunteering.

"I think it's wonderful that they give people this opportunity to not just take handouts -- but to help out when you can give back. They are certainly helping me," she said.