Morality and legality collide in the ER (5×8 – 4/30/12)

The prepay debate, should public radio reveal when story subjects are underwriters, women in the Oil Patch, spam on the phone, and don’t mess with Peggy.


The Monday Morning Rouser:

1) THE PREPAY DEBATE

What appeared to start as a data privacy breach has mushroomed into a moral debate in the hospital industry following last week’s semi-bombshell that Fairview Hospital in the Twin Cities was sending debt collectors after patients before they were treated for whatever illness brought them to the hospital.

It started over the release of patient data to the collection outfit, but now it’s morphed into a wider controversy over when and how hospitals — or at least, Fairview — get their cash from patients.

Fairview, for its part, is providing a great example of how not to handle crisis communication, first pointing out that it broke no laws, and then “apologizing” to those who felt aggrieved.

From the Pioneer Press:


“I don’t believe that we actually have done something that’s impaired the clinical care of an individual patient,” Eustis said, although he said some patients might think differently.

“If they feel that way, it’s real,” he said. “So, we want to honor that feeling and be respectful. But I honestly believe we have not done anything that’s put any patient in jeopardy by delaying or getting in the way of the care process.”

Eustis is Mark Eustis, Fairview’s CEO, who also has a son who works for the collection company, the Star Tribune reported on Saturday.

Fairview has insisted that no laws were broken in its methods, but there is legality, and then there’s morality, suggests Crain’s Chicago Business columnist Joseph Cahill:


The activities Ms. Swanson describes were systematic, high-profile and cloaked in the kind of jargon that emanates from corporate strategy gurus. For example, the attorney general says Accretive called bedside collections a “future front initiative.” A computer program supplied by Accretive prompted hospital registration clerks to collect co-pays and deductibles from patients before treatment, based on estimates that didn’t always turn out to be accurate, according to findings Ms. Swanson released last week.

The report also alleges that Accretive set collection quotas for ER workers and posted their scores for all to see. Accretive managers handed out cash gifts and promised to wear goofy costumes to work if teams hit collection goals, the report says. Ms. Tolan is responsible for the firm’s ethics.

If these things happened, something stinks all the way to the top of Accretive.

It’s a view not shared by D.J. Tice, the Star Tribune’s commentary editor…


But it’s hard to condemn reasonable attempts to collect from everyone else. The basic logic behind seeking advance payment is obvious. Why do ever more gas stations insist that you prepay or pay at the pump?

For that matter, what is the much-discussed individual insurance mandate in Obamacare but the biggest of all demands for upfront payment for health care services?

Meanwhile, the biggest advance-payment demand of any kind would be … taxes. Your employer is required to withhold from your paycheck income taxes and payroll taxes (part of which pays for Medicare benefits you will only receive years or decades later). This forces you to pay the government a portion of your wages before you ever receive them.

Wouldn’t it be more respectful of your human dignity if the government could just trust you to pay up when you can?

A reader points out what Tice didn’t mention. People with insurance do pay in advance for their health care:


The point in all of the recent stir about having a collection agency in the hospital was that the bill collectors were immersed in the middle of emergency care, at a time when pain, confusion, fear and all sorts of other emotions are overwhelming the patient and their family. The last thing we need is to have another (avoidable) stressful event intruding into the setting where the ONLY thing that matters is good quality care administered in a timely fashion. All sorts of analogies come to mind, and some of the ones you bring forward are OK for a business model for non-life or health threatening situations. But please stop and think before typing, to be in an emergency room or hospitalized nowadays means you’re pretty darned ill, and those who deal with patients have known for decades that stress makes healing and therefore discharge to home, a longer process.

Meanwhile, the Chicago Tribune reports, other hospitals that use Accretive Health are not reporting any problems. We’ll see whether any patients at those hospitals come forward with a different story, or whether the aggressive debt collection is unique to the local hospital.

On Sunday, Accretive issued a scathing press release on the situation:


The very serious allegation of denying access to patient care is flatly untrue. We take seriously our obligations under EMTALA (the Emergency Medical Treatment and Active Labor Act) and work with our clients to structure their procedures in the emergency room setting to comply with EMTALA. The specific example used by the Attorney General to support these allegations – that a father was approached for payment prior to his child being provided care – was in fact, the opposite. Our review of the records of that instance show that a family member made a special request to consult about financial arrangements and the expected cost of care in advance of treatment. We accommodated his request, and the father expressed his appreciation for our assistance.

Nevertheless, we take any patient’s concerns seriously. One of our fundamental principles is that patients should never believe that the critical work we do has interfered with their access to care. We are committed to understanding and addressing any situation where a patient expresses concern.

2) THE FIVE-HOUR CONTROVERSY

Should public radio news stories carry a disclaimer when they concern underwriters (sponsors)?

National Public Radio’s Audie Cornish did a segment on a five-hour energy drink recently and that got some NPR listeners upset because the drink company is an NPR underwriter (wait! Smart people drink that stuff?).

But NPR’s ombudsman is taking an unusual stance on the question of ethics, arguing that there’s no inherent duty for journalists to point out a conflict that, he says, doesn’t exist:


If anything, these latter are often interested in advocating a message and thus more prone to want to interfere in the news. Companies are most interested in getting their name before NPR’s audience. They are, in other words, more interested in you than they are in NPR’s journalism. NPR’s sponsors might at the same time be advertising in The New York Times, The Wall Street Journal and Fox News. Maybe even the Rush Limbaugh show.

American corporations have been trained for more than a century that there is a firewall between advertising and editorial in the professional mainstream media, and this firewall exists in spades inside NPR. We have, sadly, become a cynical people in recent years, quick to believe that sinister forces are somehow at work in much of public life, and, so, many readers may guffaw about firewalls. They are wrong.

One reader on the ombudsman’s page lists dozens of reasons why the ombudsman is wrong.

(h/t: Julia Schrenkler)

3) THE WOMEN IN THE PATCH

Being a woman in the male-dominated oil patch of North Dakota hasn’t been a problem for Ale Broschat. But “forget about being girly or anything like it,” she tells the Fargo Forum.

She has a degree in chemical engineering and was looking for work in Mexico City for six months before she got a job with the company doing work in NoDak.

Meanwhile, a former Thunder Bay preacher who moved to Alberta to protest the oil sands project there, and spent two years in prison for his opposition, has died of cancer, the CBC reports.

4) SPAM ON THE PHONE

If a presidential candidate wanted to win in a cakewalk, he’d promise to end spam. But world peace, a robust economy, and a mission to the moon and Mars are easy to accomplish that eliminating unwanted e-mail, apparently. Today, the San Francisco Chronicle reports, spam messages have now successfully made the jump to your cellphone and there’s no stopping it now.


The number of U.S. spam text messages rose 45 percent last year to 4.5 billion messages, said Richi Jennings, an industry analyst. The surge is costing carriers money and frustrating users, who must pay for the messages and deal with the influx of potentially fraudulent texts.

Spammers can get phone numbers from the Internet, or use software or websites to randomly generate thousands or even millions of numbers in a particular area code. Often using prepaid phones that can’t be traced back to the sender, they can then use auto-dialing technology to reach recipients.

5) DON’T MESS WITH PEGGY

Five years ago, Peggy McAlpine set the record for being the oldest person to paraglide. She was 99. Then a 101-year-old American broker her record. So she went back to the mountain to reclaim it.

‘I enjoyed every minute of it. It was better than the last time. I would certainly like to do it again – especially if anyone takes my record,” she said.

Bonus I: Pinnacle Airlines’ bankruptcy from the inside. “Sam,” the Minnesota airline pilot who blogs at “Blogging at FL250″ assesses the demise of the regional air carriers.

Bonus II: Where does vision come from? Are visionaries born or created? Writer and adventurer Lane Wallace migrates to the TV.

TODAY’S QUESTION

The U.S. House passed a cybersecurity bill last week that encourages private companies and the government to share information gathered on the Internet. The stated purpose is to prevent attacks on the Internet and computer-dependent facilities, but critics warn that the bill will erode personal privacy. Today’s Question: Do you trust the government to use private information responsibly?

WHAT WE’RE DOING

Daily Circuit (9-12 p.m.) – First hour: NASA has just retired its space shuttle program and many people are wondering what this move will mean for the future of American space travel and innovation. Journalist Michael Belfiore argues that private funded rockets are the future of space and with Elon Musk’s private SpaceX rocket set to dock with the international space shuttle next month, he may be right.

Second hour: May has been declared the first annual ‘Minnesota Museum Month,’ a statewide celebration of events and exhibits at local museums. The event kicks off with the 106th annual meeting of the American Association of Museums in the Twin Cities. We’ll be joined by two museum directors to talk about innovation and the future of museums.

Third hour: “When will you have kids?” seems like an innocent question, but it can be quite loaded. The New Yorker recently stoked the debate with a philosophical look in a recent piece, “The Case Against Kids”. So many factors from economics, career considerations to concerns for the greater good can affect a person’s or a couple’s decision. What are the nuances to making the big decision?

MPR News Presents (12-1 pm): On the anniversary of the end of the Vietnam War (in 1975), a special report from American RadioWorks, “Vietnam and the Presidency.”

Talk of the Nation (1-3 p.m.) – First hour: The effects of anti-immigration legislation. Supreme Court justices seem inclined to uphold parts of the controversial immigration law Arizona passed two years ago. Since then, Georgia, Utah, Alabama and other states followed suit. So, what’s changed for immigrants, for business, and law enforcement since these laws hit the books?

Second hour: The Kennedy Center’s newly appointed artistic adviser for jazz, Jason Moran, joins us on International Jazz Day.

All Things Considered (3-6:30 p.m.) - Teresa MacBain says she felt the call of God when she was only six years old. As an adult, she became a pastor. But eventually, she became a doubter of her own beliefs. NPR will have the story of a clerical crisis in faith and a conversion to atheism.

April is the month when officials warn people about the dangers of distracted driving. The Minnesota Department of Health says traffic crashes were the leading cause of death for 15- to 17-year olds in the last decade. For those young drivers, texting can be a tempting distraction. It’s illegal to text and drive in Minnesota, but some people do it anyway. In a new installment of our Young Reporters Series, 18-year-old Asma shares a coming-of-age story about learning to drive, resisting the texting temptations and how driving will change her family relationships.

Sports and art don’t mix, or maybe sports fanatics and art lovers don’t mix, but that doesn’t mean the Minneapolis Institute of Arts shouldn’t try to get them to mix. “The Sports Show” at the MIA, looks at the role of images and photography in the rise of sports as a global phenomenon. Chris Roberts takes a look at the exhibition, accompanied by St. Paul Pioneer press sports photographer Ben Garvin.

  • Jim G

    My wife goes to a Fairview Clinic. Recently her female doctor resigned leaving only male doctors to choose from for her primary care physician. Then this egregious behavior by Accretive and Fairview comes to light. She’s shopping for another clinic and female physician. She’s a smart woman so she’ll probably choose a less “morally challenged” health provider.

  • Sue

    I would say that you need to pay for the service or services that you receive no matter the time or circumstances.

    When you receive a service it is your obligation to pay for said services – ER in this case. We as a society we have chosen this system. It costs money to run these places between equipment and staff. Healthcare is ultimately a business and the hospitals need to get their employees and bills paid. Just like any other business.

    If we (as a society) don’t like the reality that the healthcare model is a business then society needs to change the health care model. The model as it currently stands is a fee for service operation.

    I am amazed that there is all this whining about getting approached about ER payments and yet we aren’t upset about the model as it stands. If you feel people shouldn’t get a bill for the services that they receive in the ER then support universal healthcare options.

    So quit whining and complaining when you are presented a bill in the ER and pay for the services you have received.

  • Bob Collins

    //If you feel people shouldn’t get a bill for the services that they receive in the ER then support universal healthcare options. So quit whining and complaining when you are presented a bill in the ER and pay for the services you have received

    There isn’t anything in this controversy that’s about a desire to not get a bill or pay for services received.

  • Jim Shapiro

    Gosh. And all along I thought Fairview was a non-profit.

    Or is that only when it comes time to pay taxes?

    Who are the corrupt, disingenuous morons again who don’t want to take care of the government’s financial problems by taxing millionaires and their corporations?

  • Jackie

    Sue, I don’t have a problem paying the bill and as Bob so rightly pointed out, that isn’t the issue here.

    If I have a co-pay, then it is paid at the time of service. But, when you have a deductible plan (or as a lot of us now have a HIGH deductible plan), you wait for the bill/explanation of benefits to find out how much you owe for the service.

    How about we get to a single rate for everyone – it doesn’t matter who your insurance carrier is or whether you are paying cash. It’s utterly ridiculous that there are different rates depending on your insurance or lack there of.

    Whatever happened to “do onto others as you would have done onto you”?

    And this is why I have told my kids that whatever you do, don’t ever drop your health insurance as at least in theory you should get treated.