Deb Waldin showed up at a Minneapolis-area emergency room one night last summer with the worst pain she’d ever felt — a kidney stone. While she waited to see a doctor, a man rolled a computer into her emergency-room bay and asked her to pay $750 or $800.
“I’m like, are you kidding me? Here I am dying and I’m just going to reach over to my purse and give you my credit card?” She kicked him out, but is still furious about it.
Waldin, 60, is just one of the patients to come forward with stories of aggressive billing tactics in the wake of a scathing report by Minnesota Attorney General Lori Swanson about hospital abuses.
In a six-volume report, Swanson described how patients were harassed and manipulated after a Chicago consulting firm, Accretive Health, introduced sweeping changes to the culture of seven hospitals owned by Fairview in the Minneapolis-St. Paul area and new strategies for collecting debts.
Hospital officials admit making mistakes that have sullied Fairview’s reputation and infuriated both patients and employees. Recently they announced that they had severed all ties with Accretive.
“They are awful stories,” Mark Eustis, Fairview’s president and CEO, said. “We don’t like to hear those stories, and we’re sorry that people have been treated that way.”
Swanson accused the consulting firm of using heavy-handed, even illegal, tactics to pressure patients for payments before, during and after their hospital stays.
Waldin, said she was still writhing in pain when an unnamed staffer pulled up to her bedside last July 11.
She had no previous debts at the hospital, she said; but the man told her this visit would cost her $750 to $800 and asked for her credit card.
Waldin had no complaints about the medical care that followed. “That was fabulous,” she said. But afterward, she called to complain about the finance man. “I don’t even recall getting an apology.”
In her report, Swanson argued that Accretive “takes pride in using collectors in the emergency room.” No area of the hospital seemed off limits: even parents with babies in the newborn intensive care units were stopped for “financial counseling,” she found.
The actions, Swanson argued, practically amounted to “a threat to withhold medical treatment.”
Mary Tolan, Accretive Health’s chief executive, said in a brief interview with the Chicago Tribune that Swanson’s report contained “a tremendous amount of innuendo and falsehoods and doesn’t represent what we do at all.
“When the truth is that you’re really advocating for patients and someone says you’re something that’s the exact opposite of that” the market fills with uncertainty resulting in undue damage to the company’s reputation, Tolan said. “These are not true assertions.”
Dr. David Hunter, a radiologist at the University of Minnesota, said he had heard complaints about the billing practices from colleagues at the university’s hospital, which is owned by Fairview. But Hunter didn’t really believe them until a couple of weeks ago, when a close friend arrived at the hospital for an MRI. The woman, a breast-cancer survivor, was ushered into a small room with a billing officer, who told her she had some unpaid bills to pay.
“She said, ‘What bills? I have paid all my bills,'” Hunter said.
The man told her she hadn’t received the bills yet, but still had to pay them. When she refused, the man pleaded that it would look bad on his record, Hunter said.
As a physician, Hunter said he was appalled. “It’s targeting people when they’re most vulnerable, which is to me ethically unconscionable,” he said.
Swanson’s report also detailed the way Accretive consultants, working in hospitals across the country, exchanged tips in private emails about how to ratchet up pressure on patients.
When a Medicaid patient in Detroit complained about harassment and called a lawyer, the Accretive employee wrote: “Now we have to waste our time to deal with this low-life patient and some dumb-ass attorney.”
If a patient balked at making a payment, hospital employees were given scripts by Accretive to wear down their resistance: “We really DO need to collect your co-pay/co-insurance/deductible today.” The implication, Swanson argued, is that patient care would suffer if they didn’t pay up.
Dan Fromm, Fairview’s chief financial officer, acknowledged that some hospital employees rebelled at the heavy-handed tactics.
He added that Fairview is trying to repair the damage with both patients and employees. “We do not and we will not let practices like that interfere with patients receiving timely and appropriate care,” Fromm said. “We underscore that repeatedly with our staff — that care comes first.”