May 29, 2012

Another Missed Opportunity in Communicating Health Care Reform: The Case of the Aggressive Collection Agency

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Udow Phillips2014

Marianne Udow-Phillips

Center for Healthcare Research & Transformation

While many have criticized the Obama administration’s communication about the benefits of the ACA (and justifiably so), few have focused on the role of the press.

The press has an obligation to inform, educate and elucidate. While they have thoroughly covered the politics of the ACA, they haven’t done nearly enough to cover the content of the law. I’ll grant you it isn’t easy—the ACA is a complex and sweeping law—but there have been many missed opportunities in this regard.

Case in point: At the end of April, the New York Times published a story about an aggressive collection agency that located staff hospitals and pursued patients for payment of hospital debts—in some cases, while patients waited in the emergency room or obtained care elsewhere in the hospital. 

The company, Accretive Health, has contracts with many hospitals to improve their “revenue cycle management.” As noted in the article, hospitals have employed collection agencies for many years to help reduce their bad debt loads. But this degree of intrusiveness in the patient care setting is new. The aggressiveness of this approach to collections reflects the increasing pressure on hospital finances, as more and more people lose health coverage or have considerably higher copays and deductibles than in the past.

The Times’ article was a good investigative piece on this new practice, highlighting the issue and raising questions about whether the practice violates the Emergency Medical Treatment and Active Labor Act (EMTLA), which requires hospitals to provide emergency care regardless of insurance status, or the Health Insurance Portability and Accountability Law (HIPAA), which requires personal health information to be kept confidential.

But the article had one major flaw: it says nothing about underlying causes, nor does it discuss any possible solutions.

And the underlying causes are truly clear: as fewer people have comprehensive health benefits, hospitals have a growing bad debt burden. The solution is also pretty clear: providing more coverage to more people to assure the financial viability of our health care system, which affects all of us, insured and uninsured alike. The fact that the article makes absolutely no mention of this (or the ACA as part of the solution) is hard to understand and, I believe, a major press failure.

Myths about the ACA abound—most notably that it is a “far left law” that will result in “federal takeover” of health care. This inaccurate view of the ACA persists in part because the press has not helped the citizens connect the dots. It is no wonder more than half of the U.S. population is still confused about what the law does or doesn’t do.

The hospital collection agency issue was a perfect opportunity for the press to help Americans make the link between harsh financial realities and a law that will allow millions to focus more on the care they need and less on the bills they have to pay. Assuming the ACA stays in effect, let’s hope that after the Supreme Court ruling and the election, the press will write more about what the law will do, and less about the political football it has become.

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