In Minnesota Hospital Debt Collection Firm Accretive Demands Payments from Patients Before They Get Treatment – Yes You Are in the Emergency Room But . . .

A Practice That Ought to Embarrass Even Conservatives – But Probably Won’t

[Update April 27:  Fairview Hospital in Minnesota now says they were 'shocked', shocked to learn there was gambling going on at Rick's unsavory and possibly illegal practices in their hospital by Accretive and that they are taking steps to terminate the relationship.]

To understand the sheer folly of the American health care system is difficult.  Such a task requires hours of devotion to technical minutia and understanding of medical procedures, processes and hospital administration.  But here’s a concept everyone can understand.  You are in the emergency room for, well for an emergency, and a hospital employee who is not really a hospital employee starts pressuring you for payments either on your coming bill or past bills.  The form of that pressure, maybe you won’t get treatment.

In Minnesota legal action by the state Attorney General  has resulted in the release of information that details policies and procedures by a company called Accretive.  This is a company that specializes in collecting past due medical bills.  Here is how they do it.

Craig Lassig for The New York Times

In November, Marcia Newton was 

shocked when she was forced to

 pay for her son Maxx’s ear tube 

surgery at Fairview Hospital even

 before he went into the hospital room.

Accretive debt-collection employees, calling themselves “financial counselors,” are instructed by the upper management ranks to stall patients entering the emergency room until they have agreed to pay a prior balance, according to the documents.

Wow, how can debt collection employees be roaming the hospitals and interacting with patients?  Well Accretive and the hospitals have figured out a way to do this.

To win promised savings, all hospitals have to do is turn over the management of their front-line staffing — ranging from patient registration to scheduling and billing — and their back-office collection activities. Accretive says it has such arrangements with some of the country’s largest hospital systems to help reduce their costs.

Indistinguishable from medical staff members, Accretive employees register patients, take down sensitive health information and champion aggressive bill collection goals with incentives like gift cards for staff members, the company records show.

And what is the result in terms of what a hospital is supposed to be doing, like providing medical care?

As part of its collection strategy, Accretive fostered a boiler-room environment at the hospitals it works with, according to hospital employees and the newly released documents.

While hospital collections increased, patient care plummeted, the employees said. “Patients are harassed mercilessly,” a hospital employee told Ms. Swanson. Another hospital employee complained, “We were told if we don’t get money from patients, in the emergency room, we will be fired.” . . . In March 2011, doctors at Fairview complained that such strong-arm tactics were discouraging patients from seeking life-saving treatments, but Accretive officials dismissed the complaints as “country club talk,” the documents show.

One can only partly blame the company.  Much of the blame must go to hospitals that engage Accretive and allow this to go on.  It is highly likely they are breaking Federal law.

By giving its collectors access to health records, Accretive violates the Health Insurance Portability and Accountability Act, colloquially known as HIPAA, Ms. Swanson said.

For example, an Accretive collection employee had access to records that showed a patient had bipolar disorder, Parkinson’s disease and a host of other conditions.

Collection employees also discussed a patient’s cancer, speculating about whether the condition was “terminal or disabling,” company e-mails show.

And some of the blame must be go to the U. S. health care system that allows people to go without health insurance and when they are unable to pay, foists their costs onto those who do have insurance or upon the medical care system in the form of bad debts and/or charity.

Maybe something ought to be done about that.  Oh wait, something was done about that, Obamacare, which is now headed for extinction in a Congress and Supreme Court near you.