Why hospitals need a conscience

Remember "St. Elsewhere"? It was a pioneering 1980s television series, celebrated for its full-fleshed characters and daring story lines.

A specific two-part episode stuck with me: It was composed entirely of third-person flashbacks from the hospital's past. The earliest is the day St. Eligius Hospital opened in 1935; its founding priest, Father Joseph McCabe, is bouncing through the empty corridors while Dixieland music blasts on its public address system. He's extraordinarily proud of getting this place built at the height of the Depression. It's his hospital, and patients are going to be well taken care of.

A quarter-century later, dramatic television has only gotten more daring and arguably even better. A sleeper HBO show called "Enlightened" seems to have a pulse on today's ethos. Its protagonist, Amy Jellicoe, is trying to rebuild her life after a nervous breakdown. She decides to do so by undermining her employer, a conglomerate named Abaddon. The company's only apparent purposes are to destroy the environment and monitor every moment of its employees' lives to enrich its bottom line. Meanwhile, Amy's juggling tens of thousands of dollars in bills for the mental health services she received.

How far removed is Abaddon from Accretive Health, the Chicago-based hospital bill collector whose conduct was so egregious Minnesota Attorney General Lori Swanson felt compelled to file a lawsuit against it last week?

According to Swanson, Accretive's people also bounced through hospital corridors--in this case, those of Minneapolis-based Fairview Health Services--but their purpose was to make sure the institution was well taken care of. Accretive allegedly stooped to dunning patients before they even received care, even urging them to go back to their cars to get their checkbooks. Swanson claimed Accretive also illegally accessed medical records to gain more leverage in its collections process.

When Fairview's medical staff actually complained that this was impeding patient care, an Accretive manager dismissed it as "country club talk." I believe the last time a doctor belonged to a country club was during "St. Elsewhere's" 1955 flashback, but corporate reality and actual reality have what are referred to these days as communication issues.

Oh, it also turned out the sons of Fairview's CEO and head of its medical group are Accretive employees. That at least sends a clear message.

Let's face it--Accretive's alleged conduct verges close to another memorable television-hospital trope: Tony Soprano snatching a pillow so he could smother his ailing mother.

I wouldn't mind seeing some of Accretive's top managers do some jail time, but I think we're going to have to just live with its stock dropping almost 30 percent after the allegations were made. It's a time of diminishing returns, after all.

There are some collections firms that take a soft approach to getting patients to pay up, such as CSI Financial Services, which I wrote about only a few weeks ago. But the alternative approach is getting far more attention. There's Carolinas Medical Center suing 12,000 of its patients who owe money, presumably for the pleasure of ruining what's left of their credit. Mount Carmel Hospital in Ohio--sort of like St. Eligius in that it's a putatively Catholic facility--popped up on NPR last Friday. It's sued 1,600 of its patients in recent years, including 27-year-old Lori Duff, who certainly would have qualified to have the $1,800 in prenatal care she received written off.

"In order to provide charity in the community--and we provide a lot and do a lot of good--we have to collect payment from those who can afford to pay us," Karen Geisler, Mount Carmel's vice president of patient financial services, told NPR in a deadpan tone. The NPR piece noted that Mount Carmel spends only 1.9 percent of its revenues on patient care--a sum dwarfed by the value of its tax breaks.

I also recently discovered a doctor in Southern California who's sued scores of her patients and placed liens on their homes and garnisheed their wages--sometimes for sums south of $50. She sued these patients even while they were still under her care, and even when they had insurance. She maintains her privileges at many local hospitals. I assure you more will come out about this later in the month.

Things aren't going to get much better for providers anytime soon. If the U.S. Supreme Court upholds the Patient Protection and Affordable Care Act, hundreds of billions in Medicare cuts will be coming down the pike. If it's struck down, 20 percent of this nation--60 million people--will be uninsured by the end of this decade.

But the tough finances have made hospitals more like the hardnosed corporations that prevail in today's business culture, and less like the charitable institutions they were originally intended to be.

The hospital executives who read this will likely shrug off my warnings that this has to stop, but it must. Otherwise there will be a large proportion of this country that will never take proper care of their health, certain it will lead to their financial ruin.

Perhaps it's a good time for some of the readership to stream old episodes of "St. Elsewhere" and "Enlightened." I'm not going to get into the conflict I have with obtaining moral guidance from watching television. But if it allows ourselves to look in the mirror, so be it. - Ron (@FierceHealth)