Hospital billing, Medicare bankruptcy stories recall old times
Notes on the news:
A new controversy may trigger familiar memories for some readers. This one centers on the activities of Accretive Health, a Chicago-based healthcare billing and collection company. The Minnesota attorney general issued a report slamming Accretive for alleged hardball tactics (April 30, p. 6). They included pushing patients to pay bills as they sought medical care, even in the emergency room. It was said to have instructed collectors to threaten uncooperative patients with lowered credit scores and urge patients to draw on unemployment benefits or borrow from relatives. Patients’ private medical records were also used in collection efforts, the report said.
Accretive customers include some of the biggest names in healthcare. Fairview Health Services, the Minneapolis-based system, said it ended its billing contract with the company about a month ago. The collection efforts at Fairview prompted the attorney general’s investigation.
Accretive executives have vigorously denied these allegations, contending the report relies on inaccuracies.
Meanwhile, some U.S. House members have asked the company for a list of clients and information on its compliance with the Emergency Medical Treatment and Labor Act. And the Illinois attorney general said she would launch her own probe.
Whatever the truth, the dispute recalls a similar national controversy almost 10 years ago. In 2003, some not-for-profit healthcare organizations, most notably Yale-new Haven (Conn.) Hospital, found themselves accused of not-so-gentle billing tactics (Sept. 22, 2003, p. 32). One particularly wrenching case involved a 77-year-old retired dry cleaner, who was paying off $40,000 in debt, including interest, from his deceased wife’s cancer treatment in 1993.
Such stories attracted government scrutiny of systems at the time.
Hospital executives ought to examine their own practices and collection outsourcing. All the “we-care-about-you” advertising can be undone by aggressive tactics. Also, citizens and politicians are unlikely to look kindly on hospitals that employ them while enjoying tax exemptions to serve the community and raking in millions in taxpayer money through Medicaid, Medicare and other programs. Meanwhile, another time-travel event occurred with the latest Medicare trustees’ report (April 30, p. 8). The report, like last year’s, projected insolvency for the Medicare insurance trust fund after 2024.
But the major deja vu comes in the annual ritual of predicting dire consequences. Last year, one Chicago Tribune columnist compiled a list of such predictions after Sen. Marco Rubio (R-fla.) repeated warnings of imminent collapse. The columnist found a litany of bankruptcy predictions going back as far as 1969, claiming insolvency would occur anywhere from 1976 to the present.
Here’s what a 2009 Congressional Research Service report on the subject said: “Almost from its inception, the HI trust fund has faced a projected shortfall. The insolvency date has been postponed a number of times, primarily due to legislative changes that had the effect of restraining growth in program spending.”
What’s disconcerting about this Beltway amnesia ritual is how some politicos seize on such predictions to try to kill rather than save social insurance programs. One helpful provision in the healthcare reform law is the Independent Payment Advisory Board, which is designed to hold down Medicare costs. This plan has been attacked by the very politicians who say they are most troubled by the prospect of a belly-up Medicare fund. Actually, they are most upset about healthcare reform itself for political and ideological reasons.
And so it goes—again.