[ Monday, June 04, 2012 ]


More on the Accretive Case: Al Franken puts on a show. One interesting tidbit: now, the Minnesota AG Swanson is claiming Accretive and North Memorial didn't have a BAA in place; in fact, she's saying they "concocted" one. If so, that's definitely a HIPAA violation that can't really be argued. If I were going after someone for a HIPAA violation, that's what I'd lead off with. However, Accretive and North Memorial both say they signed one, but can't locate it, and have since signed a replacement. So there is at least some dispute about this issue.

Accretive is in the business of helping hospitals get paid for the services they provide by the people who receive and benefit from those services. Those aren't "boiler room style sales" tactics, like AG Swanson says: nothing is being sold, and no pressure is being put on people to buy something they don't want or need. These are legitimate debts for costly services truly provided to the debtors. Did some of the Accretive tactics violate fair debt collection laws? Maybe, but you sure can't tell anything definitively from the Swanson report or from Senator Franken's hearing. What you hear is a lot of bluster and name-calling and emotionally overwrought stories, and precious few facts, from the government enforcers.

There's an axiom for trial lawyers: when the facts are with you, pound on the facts; when the law is with you, pound on the law; when neither the facts nor the law are with you, pound on the table. There's a awful lot of table-pounding going on here.

Jeff [8:58 AM]

I watched the entire hearing, and didn't see the fist pounding that you refer to. Rather, I thought Franken was way too soft on Accretive Health. These people have no business being in people's hospital rooms, period.
John, you're being too literal. I'm talking about AG Swanson's brief and entire handling of the case. After a year's worth of investigation, all her report has come up with is some emotional stories and a couple of emails where low-level staffers called non-paying patients "deadbeats." She says Accretive "may have" violated HIPAA, without specific allegations (failure to have a signed BAA is a violation, but that came out after the report), and "may have" violated fair debt collection practices.

At a restaurant, are you offended when the waiter shows up at your table with the check, and expects you to pay it? "These people" are either the hospital employees, or contractors to the hospital, and what they are doing is no different from the waiter asking for the check. Unless they've violated some debt collection law (contacting someone who has filed for bankruptcy, calling after hours, calling after the person asked them not to call or calling a number they were asked not to use, for example), then why is asking for payment for services provided inappropriate?
It's inappropriate whenever there are bodies that may be stacking up. (And you thought A.G. Swanson was being emotional.) Please see the comments section here by user DeadlyDismissal (click on "expand all comments") for an explanation: http://www.forbes.com/sites/insidearm/2012/05/22/why-the-media-cant-handle-the-truth-about-accretive-health/#comments
Bodies stacking up? I'm not following you. Is the implication that people are dying, and the billing personnel should be providing patient care?

I don't see the connection to Deadly Dismissal's rants. He seems to want a Canadian health system. That's an entirely different discussion.

People with medical debt may delay getting care? I believe that. I'm also sure that some people without insurance delay getting medical care, even if they don't already have medical debts. That's why I have insurance. Already, my insurance pays for their emergency care, but apparently my insurance should pay for all of their care (even if they could pay for their care, just so they won't be bothered by someone asking them to pay)?

Look, if you're old, you get Medicare. If you're poor, you get Medicaid. If you're neither poor nor old, you really should be responsible for yourself and your dependents. If the worst thing that happens is someone calls you a deadbeat, I don't think that calls for the state AG's office to unleash regulatory hell on the healthcare providers who think they ought to get paid or the businesses that help them collect the debts that are owed to them.

There's no rational basis for saying that the people who got the services shouldn't have to pay for them, or that the people who provided the services shouldn't be allowed to try to get paid (assuming they follow the HIPAA and FDPA rules, which is appears they did). Being no rational argument, you're left with an appeal to emotions. Which encapsulates the Swanson argument.
If one reads through the comments section in the article you cite, including the thumbs ups and thumbs downs, it becomes clear that your opinion is not the mainstream one--in fact, it's decidedly at odds with the prevailing reader opinion. Moreover, one persistent commenter was repeatedly thumbs downed and then corrected for using the same argument as yours. The response was that people who testified at the hearing weren't people who "don't pay their bills" as you both suggested, nor would they agree that the hospital "should never ask them for money."

I'd ask you to consider that emotion isn't always tied to hysteria or lack of reason. Sometimes it might be a clue that empathy and decency have been too far submerged. I think the leadership at both Fairview and Accretive Health now agree that things might have been better done differently, at least in some instances, and I hope all are working toward changing negative aspects of that former culture. Otherwise, a regulatory nudge in a new direction may be required.
Sorry, John, that I delayed moderating your comment. I have a real job other than the blog, and didn't want to post it without having the chance to respond. If that's not satisfactory to you, I'll happily refund your subscription fee.

First of all, my opinion is that there wasn't a HIPAA breach. I stand by that. Why? Because there wasn't a HIPAA breach (with regard to the patient encounters -- the laptop theft may well have been one, but a fairly common one and one that seems to have caused no harm to the patients involved). Stubborn facts.

I disagree with you about whether my opinion is the mainstream one. I think it pretty clearly is. I think the majority of the comments on that post were much more extreme than mine. But regardless, I'm not a big fan of American Idol -- I'm more concerned about being right than popular. I look at the facts and what the contestants/litigants are saying, and form my judgments based on this.

This case does expose the crux of the problem in healthcare -- people thing they should get it just because they want it, and that someone else should provide it to them for free (or for as little as the recipient wants to pay). There is no healthcar fairy dispensing free healthcare. "Free" care, of the sort touted by HHS in the contraceptive/women's health mandate, isn't "free:" SOMEONE is paying for it. It is an emotional impulse to say that these unfortunate patients (they're not "poor," at least not literally, or they'd be on Medicaid and this wouldn't be an issue at all) "ought to have" healthcare; it is not a reasoned response, and it's no way to run a healthcare system, at least if you want it to be successful. Because a healthcare system modeled on emotion is unsustainable.

Emotion isn't always tied to lack of reason or hysteria (one could read my response as emotional -- it's not, but you could interpret it that way -- but it's clearly not hysterical). But emotion is not tied to reason either. And as noted above, the emotional response "those people should not have to be bothered by bill collectors even though they haven't paid for their care, and instead should get their care for free" is clearly untethered from reason. In this case, the emotional response is not tied to reason.

What is frankly frightening in your response is that if Fairview and Accretive didn't show enough "empathy and decency," there should be a "regulatory nudge" applied to them. Basically, the full force of the federal government should be enlisted to ensure that commercial enterprises show the sufficient level of governmentally-approved empathy and decency?

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