Taking a Stand on Bill Collection Efforts
For Minnesota Attorney General Lori Swanson, the case against Accretive Health Inc. started out as a straight-forward HIPAA violation investigation.
An employee at the Chicago-based revenue cycle management and debt collection firm lost his company laptop in a smash-and-grab while his car was parked at a Minneapolis restaurant. The unencrypted computer contained health records for more than 23,500 people.
As prosecutors began investigating the theft they also began to hear troubling reports from patients and Accretive employees about the company's business practices at three hospitals it had contracted with in Minnesota.
"I personally met with over 60 patients who were asked to pay money in the hospital. It was just unbelievable what was being asked of them," Swanson says. For one patient, "we call her Jane Doe No. 3 in the papers, she was having a miscarriage. Pregnant with her first child, she went to the ER and they demanded right there in the middle of the miscarriage that she pay on a credit card. She did lose her baby that night. That kind of conduct has no place in an American hospital," Swanson says.
In July, Accretive agreed to pay the state of Minnesota $2.5 million, which will be put in a restitution fund to compensate patients. Also as part of the settlement, Accretive is banned from doing business in the state of Minnesota for at least two years and cannot reenter the state for six years without the consent of the attorney general. The attorney general had alleged violations of state and federal health privacy laws and state debt collection laws. The settlement contains no admission of liability or wrongdoing, Accretive noted in a statement.
The Robotic Surgery Jedi
Hiep T. Nguyen, MD
Growing up in the small Nebraska town of Imperial, a refugee and immigrant from the Vietnam War, Hiep T. Nguyen, MD, says he felt like an alien. When the Star Wars movie series took off during his boyhood, Nguyen closely identified with Luke Skywalker's character. Nguyen loved science fiction, robotics, and technology, but he could never determine how to build a career from what he says became a "serious interest."
A force was also within Nguyen from a young age, a drive to give back to his community. Following the example set by his father, a general internist, Nguyen went to medical school at the University of California San Francisco, specializing in urology after his first rotation in pediatric urology. During his residency, robots began to be used in surgery, and there was the merge Nguyen was looking for—science fiction became reality in the OR.
At Boston Children's Hospital, he works as an attending urologist and the director of the Pediatric TeleUrology Service. As the director of the Robotics Surgery, Research, and Training Center, Nguyen coordinates the 40 or more robotic projects the department works on simultaneously.
Nguyen led a VGo robotic telepresence project, which allowed the hospital to monitor patients at their homes using robots, reducing repeat hospital visits and saving money.
Under Nguyen's leadership, Boston Children's Hospital formed the International Health Center at the hospital, through which it coordinates trips and educational programs internationally. Once a year, Nguyen travels to a developing country to establish or check in on training programs.
"People criticize technology and say it costs too much or it's dangerous, but it is evolving, and we are evolving, and we can't be everywhere at once. Technology is essential to the evolution of medicine and the demands of healthcare," says Nguyen.
Giving Life to Hope in the Desert of the Underserved
Ellen Beck, MD
Ellen Beck, MD, has long held the funny notion that healthcare should be a right, not a privilege just for those who can afford it. "I'm from Canada," the clinical professor in family medicine at UC San Diego Medical Center says with a laugh.
Shortly after accepting a job as director of Medical Student Education for the Division of Family Medicine in the Department of Family and Preventive Medicine at UC San Diego, where she also would treat patients, she recalls, "I saw a desert of access to care for the underserved, and it was very troubling to me."
Many of her medical students saw the same thing. They came to her asking if they could provide free care to these underserved patients, arguing they both would benefit from the experience.
Those goals came together in 1997. What started as a classic grassroots effort became the UCSD Student-Run Free Clinic Project for the underserved, based in a beach area church, at first using money from student bake sales, along with university support.
Fifteen years later, the clinic has expanded to four sites within San Diego, two of which run during off hours out of community churches and two in public elementary school buildings. The medical portion of the operation is funded with about $1.5 million a year from foundations, private donations, and the medical school. Millions more come from in-kind contributions such as discounted lab testing and volunteering doctors.
"Our students come in to medicine with passion and compassion," Beck says. "And programs like this keep those emotions alive. It gives them a sense of ownership and reminds them why they wanted to become doctors. They learn how to build relationships with their patients."
Helping Patients Navigate the High Cost of Care
Gerilynn Sevenikar, vice president of patient financial services for the 2,092-licensed-bed Sharp HealthCare System in San Diego sees herself as upbeat, but her optimism was surely tested in 2009. The balance sheets weren't looking good: Collections from the uninsured population were decreasing, while unemployment was increasing in San Diego County.
But Sevenikar found ways to help the uninsured or self-pay patient population gain federal or state funding, and also opened the door for Sharp to obtain millions of dollars in payments it would not otherwise obtain. She also has tried to make the bureaucratic process more manageable for patients and more efficient for providers.
One of the key actions that Sevenikar took was helping Sharp team up with Foundation for Health Coverage Education, a San Jose, Calif.–based nonprofit that assists in helping people understand their healthcare eligibility status. The effort has resulted in helping more than 32,000 self-pay patients "navigate through a maze" of government health coverage programs, Sevenikar says. Over three years that Sharp has partnered with FHCE and through other internal initiatives, it has recovered $4.7 million in revenue, according to Sevenikar.
Within the first two years, payment collections increased 6.5% and 4.4%, Sevenikar says. "We're getting more cash back from our patients, but the better news is that we're getting letters from our patients saying how much they appreciate this..."
Sevenikar says that patient satisfaction is a crucial element of what she does. "When you are thinking about patient billing and collections, the bottom line is, 'Are you doing the right thing?' "
This article appears in the December 2012 issue of HealthLeaders magazine.