AG report: Fairview embedded debt collectors in hospital

Checking into a hospital, particularly during a medical emergency, can be a confusing and intimidating process.

But should patients who go to the hospital for medical care expect to encounter a debt collector at the registration desk?

Apparently, some hospitals, desperate to recoup mounting losses associated with unpaid patient bills (which totaled $39.3 billion in 2010), aren’t waiting until patients have been treated and go home to send collection agencies after them. Instead, the hospitals have begun embedding “stealth” debt collectors among their own personnel.

On Tuesday, light was shed on this ugly situation here in Minnesota.

Writes Pioneer Press reporter Christopher Snowbeck:

A Chicago-based consultant hired by the Fairview health system pushed hospital workers to engage in overly aggressive bill collection tactics that included pressuring patients in the emergency room, according to an investigative report released Tuesday, April 24, by Minnesota Attorney General Lori Swanson.

Accretive Health Inc. imposed quotas on hospital personnel to collect money before treatment was provided in some cases, according to Swanson’s report, and ignored concerns from some Fairview workers that the tactics were going too far.

The report described Accretive’s methods as being akin to those “commonly utilized in high-pressure boiler-room-style sales atmospheres.”

And this from Tony Kennedy and Maura Lerner at the Strib:

Swanson’s probe found that Accretive employed collection quotas, cash inducements and in-house competitions using National Football League team names to motivate staff members to squeeze upfront payments from patients. At patient registration desks, for example, employees were told to follow lengthy scripts, written by Accretive, to press patients for payments before they got treatment, according to the six-volume report.

In one case, a child who sought treatment at the University of Minnesota Amplatz Emergency Room reportedly was kept waiting while the parents, who were uninsured, met with an Accretive “financial counselor.” The incident prompted the hospital’s own employees to question whether Accretive was violating federal law, which requires emergency rooms to see patients without such delays.

According to the attorney general’s report, Accretive was derisive of such questions and complaints, even when they came from doctors. “I’m assuming this is a country club conversation that is getting floated around,” an Accretive manager wrote in an e-mail to another employee.

North Memorial

Fairview said on Tuesday that it has stopped using Accretive to collect its debts, although the hospital also said it continues to use the company to help control other costs.

Accretive also contracts with North Memorial Hospital. Swanson told reporters that she’s been trying to investigate that relationship, but North Memorial officials have been uncooperative. The hospital released a statement Tuesday in which it said it was providing information to the attorney general “in a manner that is as timely as possible.”

Accretive has issued a statement as well. “We have a great track record of helping hospitals enhance their quality of care,” it reads. “For example, we have helped over 250,000 patients get insurance coverage.”

A disturbing trend

This story may be new to Minnesota, but it’s not new nationwide. Kaiser Health News ran a related story earlier this year:

Last year, about 80,000 emergency-room patients at hospitals owned by HCA [Hospital Corporation of America], the nation’s largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency.

Led by the Nashville-based HCA, a growing number of hospitals have implemented the pay-first policy in an effort to divert patients with routine illnesses from the ER after they undergo a federally required screening. At least half of all hospitals nationwide now charge upfront ER fees, said Rick Gundling, vice president of the Healthcare Financial Management Association, which represents health-care finance executives.

For patients, this is a disturbing trend. Up to 7 percent of emergency room patients who are found to have “routine” medical issues are admitted to a hospital within 24 hours, according to an emergency room physician interviewed by Kaiser reporter Phil Galewitz.

As Swanson told Minnesota Public Radio reporter Elizabeth Dunbar about the Accretive revelations: “It’s something new and it’s something troubling. This is a case of money and medicine not mixing very well.”

You can read a New York Times story on the subject here and the attorney general’s report here.