What's an ER's First Mission?

... To heal the sick and injured, or to collect on past-due bills?

Imagine this situation: You slip and fall, and realize that the blood gushing from your leg is not going to be fixed with a small Band-Aid. So you head to the nearest emergency room, where the first person you are met by is:

(a) A triage nurse
(b) An ER doctor
(c) A debt collector

The most likely answer is: Any of the above.

Today's New York Times has a depressing article by Jessica Silver-Greenberg outlining the "tough tactics" (I can think of other words) used by Accretive Health, "one of the nation's largest collectors of medical bills."

Now under investigation by the Minnesota attorney general, Accretive was known for "embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment."  (emphasis added)

To patients, the debt collectors may look indistinguishable from hospital employees, may demand they pay outstanding bills and may discourage them from seeking emergency care at all, even using scripts like those in collection boiler rooms...

In possible violation of federal privacy laws,  Accretive employees reportedly "had access to health information while persuading patients to pay overdue bills."

Yes, hospitals are in a crazy situation here, required by law (the Emergency Medical Treatment and Active Labor Act, passed by Congress and signed by then-President Ronald Reagan in 1986) to provide emergency medical treatment to anyone who needs it regardless of ability to pay (or citizenship or legal status). In a still-reeling economy, people have let insurance policies lapse either through an inability to make the payments or through loss of jobs (and employer-provided coverage, followed by the inability to pay for private insurance). The ER has therefore become the go-to place for medical care.

And, Yes, health care is expensive, and hospitals have a right to try to recoup their costs. But it's how you do it that makes all the difference. It's certainly true that

Hospitals have long hired outside collection agencies to pursue patients after they have left hospital facilities. But financial pressures are altering the collection landscape so that they are now letting collection firms in the front door.... 

To achieve promised savings, hospitals turn over the management of their front-line staffing — like patient registration and scheduling — and their back-office collection activities.

Doesn't that sound uncomfortably cozy to you? Doesn't it sound like a situation just asking for abuse? How is "looking indistinguishable from hospital employees" ethical behavior?


I believe that health care should be a basic right, along with public education, police and fire protection, and the like. And just as we don't run our police departments on a for-profit model, thankfully, we shouldn't be running health care on that model.

Article 25 of the United Nations' "Universal Declaration of Human Rights", adopted in 1948, includes the following: "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services..."

But you can disagree with me about health care as a right, and still agree that Accretive's behavior stinks.