Un­pleas­ant mem­o­ries

Hospi­tal billing, Medi­care bank­ruptcy sto­ries re­call old times

Modern Healthcare - - OPINIONS EDITORIALS -

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.

NEIL MCLAUGH­LIN

Man­ag­ing Ed­i­tor

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