It’s not unusual to see a nurse or doctor hovering after you’ve delivered a baby, come out of surgery or landed in the emergency room. But a bill collector?
Hundreds of documents released this month by Minnesota Attorney General Lori Swanson revealed that one of the nation’s largest debt collectors, Accretive Health, "infused" itself into a Minnesota hospital chain, coaching employees to ask patients for payment at the bedside, sometimes before they received treatment.
Who is Accretive Health?
Accretive Health was started in 2003 by the New York private equity fund Accretive, LLC, which has a controversial history in Minnesota related to the arbitration and collection of debts. It is based in Chicago.
Its CEO is Mary A. Tolan and its board chairman is J. Michael Cline, founder of the Accretive equity fund.
Intermountain Healthcare in 2011
22 » hospitals, 185 clinics in Utah and Idaho
135,953 » hospital admissions
463,872 » ER visits
2,563,492 » clinic visits
$3.57 » billion net revenue
The tactics have discouraged some patients from getting care, alleges Swanson, who is suing the Chicago-based company for violating patient privacy, debt collection and consumer protection laws.
The legal battle and a six-part regulatory report Swanson published have shined a hot light on billing practices embraced by hospitals across the country, including Utah’s Intermountain Healthcare.
Like Fairview Health Services in Minnesota, Intermountain signed a five-year contract to have Accretive help manage its entire revenue cycle, from the scheduling, registering and admitting of patients to back-office billing functions.
And like Fairview, Intermountain is a non-profit — a status it risks jeopardizing by fusing with a publicly-traded company intent on turning profits, say consumer advocates.
"Charitable hospitals get a huge subsidy by not paying their taxes, billions of dollars a year. It’s a legal status, but also a social contract," said Corey Davis, an attorney at the National Health Law Program in Washington, D.C. "If you’re embedding debt collectors in ERs, most people would say that’s uncharitable."
Intermountain says its relationship with Accretive is different, both more collaborative and more expansive.
Utah’s health giant struck a deal with the company in November, and has no plans to cancel it, but "constantly monitors [its] contractual relationships to ensure all activity is in accordance with our mission and values," said Intermountain Finance Vice President Greg Johnson.
The agreement is rolling out in phases, starting with the installation of Accretive’s billing software at McKay Dee Hospital in Ogden and Logan Regional, he said. By year’s end, all 22 hospitals and 185 clinics in Utah and Idaho will be linked.
Together, Intermountain and Accretive will create a Center of Excellence in Salt Lake City with the goal of bringing more jobs to Utah and "raising the bar" in hospital billing, said Johnson. The center will sell its services to other providers.
Accretive brings to the table software that predicts for patients the cost of their medical care, he explained. The firm will largely train Intermountain employees to set up payment plans for patients, enroll them in public insurance programs and find other resources to help pay the bills.
Intermountain brings an unflinching focus on patient care, Johnson said. "We talk a lot about our mission and values. It’s kind of baked into our DNA. I don’t see that changing."
The health care industry, however, is in great flux.
Hospitals are struggling to serve growing ranks of uninsured even as insurers and government safety nets look to contain spending. U.S. hospitals lost $39.3 billion in unpaid bills in 2010, about 5.8 percent of their total expenses, according to the American Hospital Association.
Enter companies like Accretive, portrayed by the Minnesota AG as an "uber-collection agency" with unprecedented levels of access to private patient data and a "numbers driven" focus at odds with the role of hospitals "as sanctuaries for those in the dawn of life, the eve of life and the shadows of life."
Accretive declined repeated requests for an interview, but filed a motion this week to dismiss the Minnesota lawsuit. In a prepared statement, the company denied Swanson’s allegations as based on "innuendo and unfounded speculation" and noted that 90 percent of all revenue it collects comes from insurers.
"The suggestion that our focus or practice is to put bedside pressure on patients to pay their medical bills out of pocket is a flagrant distortion of fact," states an April 29 press release. "We examine each and every episode of care to ensure that patients are not improperly charged and that the insurance companies are held accountable for what they owe to providers."
Indeed, hospitals asking for cash up-front is nothing new.Next Page >
How is it going?
Patients, share your story. How have Intermountain’s bill collectors treated you? What is the health system’s track record and how is it changing? Email kstewart @sltrib.com.
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