Mayor Rahm Emanuel muscles in on Minnesota Attorney General Swanson's investigation.
Chicago's political heavyweight of a mayor must have amazing time-management skills. Not only is Rahm Emanuel running one of the nation's largest cities, he's now micromanaging the Minnesota attorney general's investigation of an allegedly unsavory medical bill collector.
Two weeks after Attorney General Lori Swanson detailed high-pressure payment practices at Fairview hospitals, Emanuel barreled into the fray to defend the Chicago contractor at the heart of the controversy -- Accretive Health, which provided bill collection and other services to Fairview.
In an imperious letter sent this week, Emanuel noted his White House connections, then leaned on Swanson, a fellow Democrat, to back off. The mayor firmly requested that she cease contact with Accretive until she meets with the firm, and told Swanson to inform him when the meeting will happen.
It's a mild but entertaining display of Chicago-style political muscle. Emanuel spokesman Tom Alexander told a Star Tribune editorial writer this week that the mayor is simply trying to make sure a hometown firm gets a fair shake.
Hometown boosterism is indeed a mayor's prerogative, but you have to wonder whether Emanuel, who served as President Obama's first chief of staff, even read Swanson's report before personally vouching for the firm in writing.
"Accretive Health is a Chicago-based Company that does important work for hospitals and good things for our city, particularly for our neediest citizens. ... Accretive Health's work is aimed at enhancing providers' financial viability and allowing them to invest in higher quality care,'' Emanuel wrote.
Not once did the missive suggest that Emanuel is concerned about the accusations of abusive behavior that have yet to be adjudicated but have been detailed at length by Swanson's office.
Alexander, the spokesman, declined repeatedly this week to say if the mayor was troubled by anything in Swanson's report. He said the mayor has demonstrated his concern by pushing to get the issue resolved.
But no matter how it's spun, Emanuel is still the political patron of a firm that dubbed its emergency-room collections as the "Accretive Secret Sauce" and bragged "Check out our ASS!"
Accretive should get the opportunity to meet swiftly with Swanson. Her allegations are serious and should be pursued in court, not just reported in the news media.
It's worth noting that the attorney general's office has long had its own secret sauce: a hardball blend of law, politics and preemptive media strikes. Accretive's attorneys have aggressively challenged Swanson's facts, but they clearly didn't realize they were up against Minnesota-Not-So-Nice.
Unfortunately, the politics could prove a distraction from unexplored concerns raised by Swanson's work. Accretive didn't just collect bills, it was helping Fairview become an accountable care organization (ACO).
This is a key federal health reform component that encourages providers to band together to assume responsibility for the care of a certain number of Medicare patients. Providers are rewarded financially for outcomes and cost control.
Swanson's report suggests that Accretive was developing risk scores to predict high-cost patients. Other providers may also rely on data-crunching contractors to become ACOs.
Are patients aware of these firms' involvement? What are doctors' concerns? Can hospitals ensure that contractors adhere to institutional values?
These are important questions. The debate over Accretive needs to evolve to address them.
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