Even in the ER, Fairview patients faced bill collectors

  • Article by: MAURA LERNER , Star Tribune
  • Updated: April 30, 2012 - 5:48 AM

Patients describe aggressive tactics they encountered at Fairview hospitals.

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When a man asked Deb Waldin to pay hundreds before she saw a doctor, “I just said, 'Go away.’” She told her story after the report was released.

Photo: Renee Jones Schneider, Star Tribune

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Deb Waldin showed up at Fairview Southdale's emergency room just after 8 one night last July 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 to this day.

Waldin, 60, is just one of the patients to come forward with stories of aggressive billing tactics in the wake of last week's scathing report by Minnesota Attorney General Lori Swanson about abuses at Fairview hospitals.

In a six-volume report, Swanson described how patients were harassed and manipulated after an Illinois consulting firm, Accretive Health, introduced sweeping changes to the culture of Fairview's seven Twin Cities hospitals and new strategies for collecting debts.

Fairview officials say they can't address every reported abuse, including those cited by Swanson.

Still, hospital officials admitted making mistakes that have sullied Fairview's reputation and infuriated both patients and hospital employees. Late Friday they announced that they had severed all ties with Accretive.

"They are awful stories," Mark Eustis, Fairview's president and CEO, said in an interview Friday. "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 Fairview patients for payments before, during and after their hospital stays -- sometimes at their most vulnerable moments.

Waldin, who lives in Edina, said she was still writhing in pain when an unnamed staffer pulled up to her bedside last July 11, shortly after a friend dropped her off at Fairview Southdale's emergency entrance.

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. "I was pretty vulnerable, being in the kind of pain I was in, but I still wasn't handing over 800 bucks," she said in an interview last week. "I just said, 'Go away.'"

He did, and 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."

Cancer survivor

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. His friend declined to be interviewed; but 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 e-mails about how to ratchet up pressure on patients.

"I have never had any luck with being a hard ass or winning arguments, but I know that at least a few of you do," wrote one. "How do you do it?"

Another replied: "I make the deadbeats feel like s... ."

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 dumbass 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.

Another set of documents described Accretive's behind-the-scenes motivational methods.

In October 2010, an Accretive manager named Sam Moen, the son of a prominent Fairview physician, offered to dress up as KFC mascot Colonel Sanders or Waldo, the popular children's book character, if employees on one unit surpassed a collections goal of $8,000 for the week. When they succeeded, he allowed the staff to vote on which costume he would wear.

"With every dollar counted, we beat our goal by $240,'' Moen wrote in an e-mail to the group.

Another document showed that Moen pitted workers against each other in collections competitions tracked on a white board in open view.

Accretive officials could not be reached for comment.

Patients walked out

In several cases, patients walked out of the hospital without being registered, Swanson reported. At least one large employer threatened to leave the Fairview system if it kept demanding credit card payments before treatment.

Meanwhile, she found, employees were cautioned not to tell patients if they were due a refund.

"Clearly that's not appropriate behavior," said Eustis, of Fairview.

Dan Fromm, Fairview's chief financial officer, acknowledged that some hospital employees rebelled at the heavy-handed tactics. "They were feeling some pressure from Accretive to approach patients more aggressively than our values and our judgment otherwise would indicate," he said.

Fromm said the last of the Accretive revenue consultants left Friday.

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."

Signs suggest things may be changing. One Edina mother, who did not want to be identified, said Fairview demanded $3,500 up front to admit her 22-year-old son into a chemical dependency program a year ago. She borrowed the money, she said, only to learn from her insurance company that she had overpaid her share.

It's taken many months, she said, but Fairview finally called to offer a refund -- on Friday.

Maura Lerner • 612-673-7384

  • THE ATTORNEY GENERAL'S REPORT

    On Tuesday, Attorney General Lori Swanson released a scathing report on Fairview hospitals' debt-collecting practices.

    COLLECTION PRACTICES QUESTIONED

    The report centered on high-pressure tactics used in emergency rooms, cancer units and delivery wards to try to collect money from patients before they were treated.

    ACCRETIVE DESIGNED STRATEGY

    An Illinois consulting firm called Accretive Health designed the strategy, and the practices were uncovered during a review of Fairview's contract with the company.

    FAIRVIEW'S RESPONSE

    The hospital issued a statement Tuesday saying it has cooperated with Swanson and shares her concerns and has dropped Accretive as its revenue manager.

    'ACCRETIVE SECRET SAUCE'

    Consultants admitted a typical hospital doesn't do financial counseling in an emergency room but boasted they had found a way to get 15 percent of ER patients to pay up front.

    MEDICAL CIRCLES RESPOND

    The report touched a nerve, and many hospitals -- including the Mayo Clinic -- clarified that they do not condone the practice of asking for payment in an ER. "I have never had any luck with being a hard ass or winning arguments, but I know that at least a few of you do. How do you do it? Shortcuts, work arounds and (legal) cheats?" Internal e-mail from a collector at Accretive's Kalamazoo, Mich., office "I make the deadbeats feel like s---, talk nicely to women who sound education/have money, and am firm with dumb f----. If they say something stupid, I make sure they know they've said something stupid." Another collector's response to the above message "Thanks. I went through the hospital notes and this is what pisses me off the most. The patient is pissed because Medicaid didn't cover this and told the hospital that she is never going to pay this. There are some attorneys who aren't skilled enough for an actual practice that work for these stupid fricken non-profit organizations who help the poor in Detroit. Now we have to waste our time to deal with this low-life patient and some dumbass attorney all because this patient didn't show up to the DHS office to renew her benefits. Ugh. I'll make sure they get a call though." A collector's response (the same day as the earlier messages) after learning a lawyer had left a message on behalf of a particular patient "Mrs Smith, my name is ______ and I'm the Financial Counselor (Admitting Rep) at [Fairview]. According to your insurance company you have a deductible of $100 and a 10% co-insurance. Based on a 3-day stay, your estimated amount due is $440. How would you like to pay for that today? We accept cash, check, debit or credit card." ("LISTEN FOR A RESPONSE ...") Accretive's instructions to its collectors on how to conduct a bedside visit if a patient is in a hospital bed accretive's correspondence Excerpts from e-mails and memos from Accretive Health relating to debt-collecting practices. All of these communications were included in the attorney general's report released Tuesday.
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