The news this week in Minnesota was that the Attorney General had negotiated a settlement with Accretive Health Care over their collection techniques. When I read the original articles and summaries on the AG's web site, it reminded me of a conversation I had with a psychiatrist many years ago. He was hired by a hospital CEO who told him that he would be responsible for reminding patients that they needed to bring their insurance card for appointments. I thought that was an odd job for a physician but chalked it up to the generally poor level of administrative and clinical support that most psychiatrists get. One of his patients complained to the CEO about this process and he was fired. Another example of medical professionalism being compromised and then scapegoated by business practice.
I encourage anyone with more than a passing interest in just how far business practices have intruded and compromised medical practice to read the scenarios described in this Pioneer Press article. Patient after patient describing a situation where they were confronted bill collectors when they were either critically ill or just before surgery. The article also contain the industry's perspective:
"Point of service collections have become fairly standard practice." (page 6A, par 5)
The bottom line here is that this is really not quite the scandal that the Attorney General and the media are holding it up to be. The reason is very simple. Managed care is the dominant force in health care markets today. They hold that position because politicians in both state and federal governments want them to have that kind of power. As an example, Minnesota Statutes have managed care tactics written into them. These tactics have misplaced any professional input from physicians a long time ago. They use their own standards - many of which are made up within the industry and have no scientific backing. Business entities do not have any ethical standards. The ethics of a business are relative and depend a lot on the executives running it. It is clearly acceptable to confront you for a co-payment or past due bill even if you were too sick to think about picking up your wallet.
There is no reason to expect that these onerous collection practices will not be routine in the future. That should be obvious to anyone who can see that the influence of medicine and medical doctors is at an all time low. We frequently hear from politicians and bureaucrats that physician influence is never coming back and we should all: "Get used to it.". Hoping for a series of activist Attorney Generals is about all that's left.
If you are critically ill and somebody asks you for your charge card and looks irritated when you don't have it - you will have the managed care cartel and the government backing them to thank.
George Dawson, MD. DFAPA
Cristopher Snowbeck. Patients, hospital see lesson in billing furor. Pioneer Press. August 5, 2012.