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Tuesday, May 29th 2012

Debt Collection Is A Brutal Business

Accretive Health provides ‘financial’ services to health systems. Chief amongst them, collecting overdue bills from patients. As the debt collection practices grow more and more aggressive, collectors like Accretive are coming under the microscope. No longer is this solely a matter of outpatient letters or calls, but instead increasingly bold steps at the inpatient level.

Hospitals have long hired outside collection agencies to pursue patients after they have left hospital facilities. But financial pressures are altering the collection landscape so that they are now letting collection firms in the front door, according to Don May, the policy adviser for the American Hospital Association, a trade group.

To achieve promised savings, hospitals turn over the management of their front-line staffing — like patient registration and scheduling — and their back-office collection activities.

Accretive Health in particular is drawing a lot of attention for actions in Minnesota. Attention going all the way up to the State Attorney General’s office.

Employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance, according to the documents. Employees in the emergency room, for example, were told to ask incoming patients first for a credit card payment. If that failed, employees were told to say, “If you have your checkbook in your car I will be happy to wait for you,” internal documents show.

Employees at Accretive’s client hospitals ask patients to make “point of service” payments before they receive treatment. Until she went to Fairview for her son Maxx’s ear tube surgery in November, Marcia Newton, a stay-at-home mother in Corcoran, Minn., said she had never been asked to pay for care before receiving it. “They were really aggressive about getting that money upfront,” she said in an interview.

In particular there is concern that employees may have violated provisions of EMTALA by discouraging patient’s from seeking care and that they and the hospitals may have violated provisions of HIPPA by having access to protected information.

Not that Accretive doesn’t have its proponents, including Rahm Emanuel who has spoken up for their body of work if not for their strategies in Minnesota.

On reading about this my libertarian tendencies surface. In general I think aggressive collections prior to care are tactless, morally repugnant and in many cases bad business. It isn’t how I would run a hospital. However, if that’s the way companies like Accretive and hospitals like Fairview want to play it then I think that should be within their rights. I’m against legislating them off of such.