Accretive Health's peculiar view of hospitals


I don't want to get into the habit of quoting New York Times columnists, but David Brooks made a relevant point last week about those currently in positions of power and privilege: "These people are brats; they have no sense that they are guardians for an institution the world depends on; they have no consciousness of their larger social role," he wrote.

Brooks was referring to the executives at the British bank Barclays and their alleged fixing of global interest rates, but he might as well have been discussing Accretive Health. That's the Chicago-based healthcare debt collection firm whose executive ranks are populated with those whose mouths apparently will not shut unless their feet are firmly inserted therein.

When Minnesota Attorney General Lori Swanson filed suit against Accretive last January, it was over alleged patient privacy violations and it drew little media attention. Then Swanson released a damning report in April that accused the firm of leaning on patients for payments while awaiting care in the emergency rooms of Minneapolis-based Fairview Healthcare Services. You could hear Accretive executives scoffing and see their eyes rolling from Jupiter.

"From our review of the record, we have been able to confirm that many of these reports are grossly distorted or flatly wrong," Accretive Senior Vce President Gregory Kazarian told the U.S. Senate during a hearing on the matter.

Accretive CEO Mary Tolan went further: She called Swanson a liar. "The truth is that you're really advocating for patients, and someone says you're something that's the exact opposite of that," Tolan told the Chicago Tribune. "These are not true assertions."

Accretive executives also repeatedly questioned why there was such a paucity of actual patient testimonials.

So, Swanson's office filed a 44-page memorandum in federal court last week with those testimonials, 21 in all.

Carol Wall was pressured to make a payment while on a gurney, suffering a stroke. Amy Morris was told an operation for her lung cancer wouldn't proceed until she produced $1,509.48. Daniel Ritter, a 63-year-old Lutheran minister, had to negotiate a demand for $1,500 to proceed with his hip replacement surgery down to $700 because that was all he and his wife could afford.

And there's Amy Zumwalde. She was told her newborn baby son Max wouldn't be discharged until she coughed up $800. The memorandum referred to that incident as "baby prison."

At least we can spring John Monteith and Anna Wittenhall and send them on their way. They were fake names Accretive put on collection letters to Fairview patients who apparently managed to receive healthcare services without first being strong-armed.

And there's some comic relief. The report refers to Accretive's in-house name for inserting its own employees into Fairview hospitals to collect from patients upfront: "Accretive Secret Sauce." One Accretive document revels in this juvenile acronym: "You've never seen ASS like ours! ... Check out our ASS!" it proclaimed.

I've been writing about the healthcare industry for nearly 20 years now, and have met and interviewed thousands of execs. Virtually none have ever uttered a vulgar word or acted any less than a fully-functioning adult. It's simply too serious a business to behave in any other manner. And I can't imagine a single healthcare finance executive who would want such a program within the walls of their institution.

How Accretive created such a twisted relationship with Fairview and its patients was simple: Fairview's former CEO Mark Eustis and head of its medical group, David Moen, M.D., both have sons working for Accretive. It turns out Moen's son was instrumental in bringing this level of debt collection into Fairview's walls. Moen also owned Accretive stock.

I sensed an even wider disconnect at the recent Healthcare Financial Management Association's Annual National Institute conference in Las Vegas. While most of the hundreds of vendors were passing out practical knickknacks like smartphone stands and pens, Accretive's booth boasted golf paraphernalia.

As far as I recall, it was the only vendor in the entire hall passing out something meant for the country club. And while I may be prejudiced regarding this matter, it seemed entirely fitting Accretive marketed itself with objects associated with organizations that are often insular, exclusive and reflexively defensive when criticized.

It therefore makes perfect sense Accretive doesn't see a hospital for what it is: an institution the world depends on.

I'll let the rest of David Brooks' words speak for themselves. And I promise to quote only myself next week. - Ron (@FierceHealth)

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