USA: Want treatment? Pay up!

Sick enough? Debt collection in US hospital ERs pre-treatment

By Paul Wallis

"The level of irrationality in US health care has gone up another notch. People are now being asked to pay pre-treatment, even in emergency rooms. This practice could involve serious medical risks for patients and major legal issues for hospitals."

Digital Journal,

24 April, 2012

The level of irrationality in US health care has gone up another notch. People are now being asked to pay pre-treatment, even in emergency rooms. This practice could involve serious medical risks for patients and major legal issues for hospitals.

The theory of asking for payment before treatment leaves a lot to be desired on ethical grounds, but on legal grounds it’s bordering on suicide. There’s even a suggestion of entrapment of patients in some information published by The New York Times.

The New York Times refers to the practices of a company called Accretive Health:

…The tactics, like embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment, were outlined in hundreds of company documents released by the (Minnesota) attorney general. And they cast a spotlight on the increasingly desperate strategies among hospitals to recoup payments as their unpaid debts mount.

To patients, the debt collectors may look indistinguishable from hospital employees, may demand they pay outstanding bills and may discourage them from seeking emergency care at all, even using scripts like those in collection boiler rooms, according to the documents and employees interviewed by The New York Times.

In some cases, the company’s workers had access to health information while persuading patients to pay overdue bills, possibly in violation of federal privacy laws, the documents indicate.

This “aggressive” emphasis on pre-payment for treatment has many obvious holes in it- Payment for what, exactly? Will further treatment/payment be required? Are sick or injured people in pain able to judge their legal rights and decline treatment on the basis of the requirement for payment? Please note that it's also highly debatable that anyone, including a doctor, let alone a debt collector, could accurately assess treatment requirements pre-diagnosis.

There are also some suggestions of violation of laws requiring hospitals to provide treatment:

(Minnesota Attorney General) Ms. Swanson said that the hounding of patients violated the Emergency Medical Treatment and Active Labor Act, a federal law requiring hospitals to provide emergency health care regardless of citizenship, legal status or ability to pay.

Does anyone in US health care have any idea at all what they’re doing?

What’s really bizarre about this is that a gigantic sector issue, and a lot of unpaid money, aren’t telling health care providers anything about their situation, despite some obvious inferences. According to the NYT article, there’s an estimated $39 billion of unpaid medical debt to the nation’s 5000 community hospitals or roughly $1000 for every human being in the US.

So, a few questions-

• Why would it be that so many people aren’t paying their bills?
• Why is this a national issue?
• Could it be that the gap between cost and ability to pay is now so gigantic that people are prepared to take the risk of debt default rather than pay
•  If the gap is so big and the amount of unpaid money so huge, why the resistance to health insurance reform to allow people to be better able to pay?
• Why aren’t hospitals insured against debt defaults, if the problem is so widespread?

There’s a degree of legal absurdity in this situation, to

Pre-service demand for money is bordering on illegality even in basic commerce, let alone health. Why pay for something you haven’t even received? How do you enforce a claim for money without receipt of service? On what basis do you claim payment? Is it based on the intent to provide a service, possibly sometime in the distant future, when the other people in the ER have died of old age? It doesn’t stack up, because it can’t.

Translation for corporates-

Medical conditions need treatment. Treatment includes major legal obligations on service providers. So good little buttercups don’t create-y-poos problems for their dear furry little selves by screwing up the basics. That means the cute little wuffly-snuffly bunnykins also make sure that people get treatment before the fan gets hit with tons of stuff for which dear little fat butts may be held liable and forced to wear clothes to go to court.

The debt collection solution is a pretty typical corporate response to any revenue problem. Never mind the realities, charge as much as you can get away with charging. Then you can frolic in the meadows with the other suits, paying yourselves a fortune for creating major commercial and legal problems.

(I’ve been saying for years that these guys in health who are infected with Spreadsheet Disease are basically unemployable. They have no perspectives, just a single minded obsession. They should be getting anti-psychotic treatment themselves.)

What this situation has to do with efficient health care is anyone’s guess. In practice, high costs are an encouragement to debt evasion in any sector. They’re a guarantee of revenue problems. In the US health care sector, high costs are now an article of faith. The sector is now high revenue-dependent, never a good sign and indicative of a heavily loaded cost structure. High cashflow cost structures are usually typical of an extremely inefficient, top-heavy industry which churns money through the system but also routinely finds itself short of money because of its cash cow status.

Perhaps most mystifying is exactly what the hell these people think health care is for. You’d think health care was some sort of luxury. Health care is a right, not a privilege. Why should anyone be denied health care for any reason? Health care is in the public interest at all levels. The guy that can see straight is safer on the roads than the guy that can’t. The person who’s not psychotic and properly medicated is probably safer as a financial advisor than the nutcase. The person who isn’t paranoid is less dangerous when holding a gun. The people getting treatment and not spreading lethal diseases are less of a risk to the society as a whole.

If you want to collect money for health care, at least acknowledge the higher values of health care. A few bucks are never going to be worth anyone’s life.