<i>The New York Times</i><br clear="all"><hr align="left" size="1">
<div class="timestamp">April 24, 2012</div>
<h1>Debt Collector Is Faulted for Tough Tactics in Hospitals</h1>
<span><h6 class="byline">By JESSICA SILVER-GREENBERG</h6></span>
<p>
Hospital patients waiting in an emergency room or convalescing after
surgery are being confronted by an unexpected visitor: a debt collector
at bedside. </p>
<p>
This and other aggressive tactics by one of the nation’s largest collectors of medical debts, <a title="Web site." href="http://www.accretivehealth.com/">Accretive Health</a>,
were revealed on Tuesday by the Minnesota attorney general, raising
concerns that such practices have become common at hospitals across the
country. </p>
<p>
The tactics, like embedding debt collectors as employees in emergency
rooms and demanding that patients pay before receiving treatment, were
outlined in hundreds of company documents released by the attorney
general. And they cast a spotlight on the increasingly desperate
strategies among hospitals to recoup payments as their unpaid debts
mount. </p>
<p>
To patients, the debt collectors may look indistinguishable from
hospital employees, may demand they pay outstanding bills and may
discourage them from seeking emergency care at all, even using scripts
like those in collection boiler rooms, according to the documents and
employees interviewed by The New York Times. </p>
<p>
In some cases, the company’s workers had access to health information
while persuading patients to pay overdue bills, possibly in violation of
federal privacy laws, the documents indicate. </p>
<p>
The attorney general, Lori Swanson, also said that Accretive employees
may have broken the law by not clearly identifying themselves as debt
collectors. </p>
<p>
Accretive Health has contracts not only with two hospitals cited in
Minnesota but also with some of the largest hospital systems in the
country, including Henry Ford Health System in Michigan and
Intermountain Healthcare in Utah. Company executives declined to comment
on Tuesday. </p>
<p>
Although Ms. Swanson did not bring action against the company on
Tuesday, she said she was in discussions with state and federal
regulators about a coordinated response to Accretive Health’s practices
across the country. Regulators in Illinois, where Accretive is based,
are watching the developments closely, according to Sue Hofer, a
spokeswoman with the State Department of Financial and Professional
Regulation. </p>
<p>
“I have every reason to believe that what they are doing in Minnesota is
simply company practice,” Ms. Swanson said in an interview, but
declined to provide details. </p>
<p>
In January, Ms. Swanson filed a civil suit against Accretive after a
laptop with patient information was stolen, saying that the company had
violated state and federal debt collection laws and patient privacy
protections. That action is still pending. </p>
<p>
An Accretive spokeswoman declined to comment on whether other states
were looking into its practices and issued a brief statement, “We have a
great track record of helping hospitals enhance their quality of care.”
In its annual report, the company said it was cooperating with the
attorney general to resolve the issues in Minnesota. </p>
<p>
As hospitals struggle under a glut of unpaid bills, they are reaching
out to companies like Accretive that specialize in collecting medical
bills. </p>
<p>
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. </p>
<p>
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. </p>
<p>
Concerns are mounting that the cozy working relationships will undercut
patient care and threaten privacy, said Anthony Wright, executive
director of Health Access California, a consumer advocacy coalition.
“The mission of these companies is in direct opposition to the supposed
mission of these hospitals.” </p>
<p>
Still, hospitals are in a bind. The more than 5,000 community hospitals
in the United States provided $39.3 billion in uncompensated care —
predominately unpaid patient debts or charity care — in 2010, up 16
percent from 2007, the hospital association estimated. </p>
<p>
Accretive is one of the few companies specializing in hospital debt
collection that is publicly traded. Last year, it reported $29.2 million
in profit, up 130 percent from a year earlier. </p>
<p>
Late last month, Fairview Health Services, a Minnesota hospital group
that Accretive provided services to, announced it was canceling its
contract with Accretive for back-office debt collection. After Accretive
informed investors, its stock plunged 19 percent in a day. On Tuesday,
the company’s shares closed at $18.49, down 2.7 percent. </p>
<p>
Accretive says that it trains its staff to focus on getting payment
through “revenue cycle operations.” Accretive fostered a pressurized
collection environment that included mandatory daily meetings at the
hospitals in Minnesota, according to employees and the newly released
documents. Employees with high collection tallies were rewarded with
gift cards. Those who fell behind were threatened with termination.
</p>
<p>
“We’ve started firing people that aren’t getting with the program,” a
member of Accretive’s staff wrote in an e-mail to his bosses in
September 2010. </p>
<p>
Collection activities extended from obstetrics to the emergency room. In
July 2010, an Accretive manager told staff members at Fairview that
they should “get cracking on labor and delivery,” since there is a “good
chunk to be collected there,” according to company e-mails. </p>
<p>
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. </p>
<p>
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. </p>
<p>
Ms. Newton was shocked to learn that the employees were debt collectors. “You really feel hoodwinked,” she said. </p>
<p>
While hospital collections at Fairview increased, patient care suffered,
the employees said. “Patients are harassed mercilessly,” a hospital
employee told Ms. Swanson. </p>
<p>
Patients with outstanding balances were closely tracked by Accretive
staff members, who listed them on “stop lists,” internal documents show.
In March 2011, doctors at Fairview complained that such strong-arm
tactics were discouraging patients from seeking lifesaving treatments,
but Accretive officials dismissed the complaints as “country club talk,”
the documents show. </p>
<p>
Ms. Swanson said that the hounding of patients violated the <a title="More about the act from the American College of Emergency Physicians." href="http://www.acep.org/content.aspx?id=25936">Emergency Medical Treatment and Active Labor Act</a>,
a federal law requiring hospitals to provide emergency health care
regardless of citizenship, legal status or ability to pay. </p>
<p>
In the January lawsuit, Ms. Swanson said that by giving its collectors access to health records, Accretive violated the <a title="An explanation of the law." href="http://www.hhs.gov/ocr/privacy/">Health Insurance Portability and Accountability Act</a>,
known as Hipaa (pronounced HIP-ah). For example, an Accretive
collection employee had access to records that showed a patient had <a href="http://health.nytimes.com/health/guides/disease/bipolar-disorder/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Bipolar Disorder." class="meta-classifier">bipolar disorder</a>, <a href="http://health.nytimes.com/health/guides/disease/parkinsons-disease/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Parkinson's Disease." class="meta-classifier">Parkinson’s disease</a> and a host of other conditions. </p>
<p>
In addition, she said, the company broke state collections laws by
failing to identify themselves as debt collectors when dealing with
patients. </p>
Late Tuesday afternoon, Accretive announced it won a contract to provide
“revenue cycle operations” for Catholic Health East, which has
hospitals in 11 states. <br clear="all"><br>-- <br>Art Deco (Wayne A. Fox)<br><a href="mailto:art.deco.studios@gmail.com" target="_blank">art.deco.studios@gmail.com</a><br>