Just when you think you’ve heard it all, a new article comes along that really underscores the need for healthcare reform. The New York Times ran an article on April 24, 2012 (“Debt Collector Is Faulted for Tough Tactics in Hospitals”) about Accretive Health’s (public company) practices to go into their hospital client’s patient rooms and start collecting money for the medical care. Yes, you read that correctly, while patients are in their hospital bed receiving medical care, they are being asked, “Will that be cash, credit card, or check?” The patients assumed Accretive staff were hospital employees, so that adds to the concern that they didn’t identify themselves, and really, even if they did, depending on the patient’s condition, it would be an easy enough mistake to make given the circumstances. The Attorney General is pursuing that angle, because Accretive should have disclosed they were a debt collection agency. When HIPAA privacy laws are introduced to the mix, the story gets even more interesting, because the collectors had access to the patient’s medical information.
Accretive specializes in revenue cycle management –as do I! Hospitals are struggling to make ends meet these days, with higher levels of charity and bad debt write offs, it is easy to see how the lines between clinical care and financial counseling can go hand-in-hand more frequently. Think about when you go the eye doctor and have to purchase glasses – refraction usually isn’t covered, the lenses may be depending on when you last had them made, frames you may get a discount, and contacts typically are not covered. Shopping optical looks more like retail, shopping at any store. Medicare has long implemented an “Advance Beneficiary Notice (ABN)” to notify patients of their financial responsibility, prior to receiving care, so they can decide if they want to get the service. Simply, medical care costs money.
I think this bedside badgering, er, billing, is ugly. As a patient, if you are asked to pay for services while still in the bed, you may be afraid to refuse payment thinking it could compromise the care you will be given. You may fear being discharged early just to free a bed for a paying patient, or you may fear being denied care all together. The NYT article describes how patients in Emergency Rooms were delayed from seeing a medical provider so the payment discussion could take place. I think EMTALA should step in there, even ABNs aren’t required in emergency and fast track settings, so we probably need to think through the desire to accelerate collections in those areas, and balance that against wait times and the need to get the patient seen timely.
I understand the drivers that caused the bedside billing. Although the economy shows signs of recovery, we aren’t there yet, and most people will pay their food, electric and mortgage bills before medical bills. Medical bills are always lower priority and fall to the bottom of the bill heap. Hospitals in turn react and try to collect payment while they have access to the patient –even if the patient is still admitted in a bed. Maybe there is a middle ground where we can put some process in place where, under certain conditions, it makes sense for hospital representatives that clearly identify their role, have that financial conversation with the patient, prior to discharge, but make it clear it no way impacts the care they will be given. Icck. As I typed it, it just sounds bad. I don’t know if there is a good way to do collections bedside, but we haven’t heard the end of this subject.
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