Debt collectors are working triage ~ Scary!

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

JESSFALLING

Full Member
10+ Year Member
Joined
Jan 17, 2011
Messages
1,114
Reaction score
8
yeah, there are some pretty strict laws regarding harassment from debt collectors, and that also seems like a pretty clear violation of patient privacy. Seems like there is a pretty strong case there for that suit. I can understand that hospitals are having issues with losing money from unpaid ED bills, but this is a bad - and potentially illegal - way of doing it.
 
Interesting. Some of the practices mentioned are, in fact, standard hospital collections practices (e.g., expectations that registrars in the ED collect copays, performance goals for collections, offering to wait for pts or their family members to get a credit card or cash, offering creative ideas for how to pay a copay at the point of service and/or at a later time, looking for which patients to target, etc.); however, others are most certainly poor practices and compromise patient care (delay of pt care for collections, allowing a debt collection agency access to health records, general harassment of pts, building any sort of 'stop list' of pts in debt, etc.). I know in the ED where I work, ED collections always occur after a pt is seen by the MD/DO/PA. This is to prevent any accusations that pt care was influenced by whether or not the pt has insurance or is able to pay. Of course, whether or not the pt is able to pay may influence whether or not the pt can be transferred to the most appropriate facility, etc.

I want to say the national average for total income collected at point of service in a hospital setting is around 3%. I know our ED was always WAY below that target (more like 1-1.5%). The reality is that hospitals do have to bring in money somehow. The questions is how to do it in an ethical manner that benefits everyone involved.
 
Members don't see this ad :)
that hospital involved is gonna lose a whole lot of money lol
 
that hospital involved is gonna lose a whole lot of money lol

I suspect it depends upon the specifics of the case. I agree with the physicians on the EM forum that this would make more sense as an EMTALA than a HIPAA issue. If anything, the debt collector here would be preventing or delaying pt care. If, in fact, that was happening, then suits for EMTALA violation would be appropriate. On the other hand, if the patients bothered in the waiting room are only those identified as ESI 4s and 5s (maybe even some 3s), then I'm not so sure it'd even really be much of an EMTALA issue (as long as pts are not being harassed and made to feel they should not be there as a result). Still not in good taste (nor something I'd want to see), but I'm not so sure a lawsuit would really fly under those conditions. As long as the initial triage assessment is never impeded and the MSE is not delayed (or prevented) as a result, I would think it would be more a matter of angry pt complaints than one of legal ramifications.

The law considered in the article, then, is HIPAA. It seems this could be due to an appeal to EMTALA falling flat. However, HIPAA does not appear to have been explicitly violated (at least from what I saw). The example given was:

By giving its collectors access to health records, Accretive violates the Health Insurance Portability and Accountability Act, colloquially known as HIPAA, Ms. Swanson said. For example, an Accretive collection employee had access to records that showed a patient had bipolar disorder, Parkinson’s disease and a host of other conditions.

That does NOT violate HIPAA as it falls under the OPERATIONS clause of the law (i.e., a medical record may be accessed for purposes relating to the operations of the organization). Unless that employee actually abused said access, no violation occurred. (Of course, the hospital's EMR could have been better segregated in terms of access and it would be preferable to avoid revealing diagnoses to billing. At the same time, these are often the people recepting a patient and so will likely be aware of such things regardless and must at least see the c/c in triage since they have to enter it into the computer there.)

Source: http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/usesanddisclosuresfortpo.html

In addition, certain health care operations—such as administrative, financial, legal, and quality improvement activities—conducted by or for health care providers and health plans, are essential to support treatment and payment. Many individuals expect that their health information will be used and disclosed as necessary to treat them, bill for treatment, and, to some extent, operate the covered entity’s health care business.


In essence, I think this hospital used poor judgment and think the company's approach is generally inappropriate; however, I would not go so far as to say anything they are doing is necessarily illegal (at least as stated in the article), although I agree it is in very poor taste. I also wonder how much spin was placed on this article. It sort of reads like a long list of what individual employees did wrong rather than an overall analysis of their approach. For example, issues such as talking about a pt's condition (disabled vs. terminal) may have been completely inappropriate one-time discussions (e.g., an employee talking about clinical issues in a moment of gossip) vs. a potentially valid discussion related to insurance and billing vs. an indication of a very gossipy and non-HIPAA-compliant company culture.
 
doesnt the article mentions that the ER tech actually works for the collection agency? that sounds so wrong at many levels
 
doesnt the article mentions that the ER tech actually works for the collection agency? that sounds so wrong at many levels

I don't recall seeing that. That would be highly suspect, although we have certainly had people work in dual Scribe-ED Registrar and Tech-ED Registrar roles (but they are always working in one dept or the other at any given time). This would place them in both financial and clinical roles. Still, an ED Registrar role is primarily clinical support. The financial element is very much secondary in emphasis (at least at our hospital).
 
Top