By Jay Hancock November 23,
2019
Prominent
doctors at UVA Health System are expressing public outrage at their employer’s
practices to collect unpaid medical debt from its patients.
A
Kaiser Health News report in September that showed
UVA sued 36,000 patients over six years for more than $100 million, seizing
wages and savings and even pushing families into bankruptcy.
Over six
years, the state institution filed 36,000 lawsuits against patients seeking a
total of more than $106 million in unpaid bills, a KHN analysis finds.
Like
many physicians who work at U.S. medical centers, the UVA doctors said they had
little idea how aggressively the hospital where they practice was billing and
pursuing their patients for payment.
Although
the health system has announced some interim measures to scale back collections
practices, some of the system’s most senior physicians are now calling for UVA
to stop suing its patients altogether. And they are urging the pursuit of an
“immediate solution” to address the national epidemic of health care debt.
“We
were appalled by the revelations of the aggressive, pitiless billing and
collections practices” at UVA, Dr. Scott Heysell and two other senior staff
members wrote in a letter to KHN published Saturday.
“We felt betrayed,” they wrote, “and we had, by extension, betrayed those who
had relied on us.”
Heysell,
an infectious-disease specialist and associate professor at UVA School of
Medicine, and his co-authors echoed other UVA researchers and clinicians
contacted by a reporter who said they were surprised and dismayed by the health
system’s practices.
UVA
initially defended its practices, pointing to the Virginia Debt Collection Act of
1988, which requires state agencies to “aggressively collect” money
owed. But within days of the KHN report, UVA said it would reduce its use of
the courts and make it easier for patients to qualify for financial assistance.
That’s
not enough, said the letter’s authors, who include Dr. Rebecca Dillingham,
director of UVA’s Center for Global Health, and Dr. Michael Williams, director
of the UVA Center for Health Policy.
They
ask “why UVA cannot join other public hospitals that have effectively stopped
suing patients altogether?”
Other
University of Virginia faculty said the system’s practices undermined their
efforts to improve care for middle- and lower-income families and was not in
keeping with an ethos of putting patients first.
KHN’s
findings “made me feel utterly hypocritical about my work and efforts to
promote health equity,” Rajesh Balkrishnan, a UVA public health professor who
researches cancer treatment in Appalachia, said in an interview.
“This
is a public university with one of the richest endowments in the country,” he
said. “At least take care of the immediate community you serve.”
In
September, UVA Health said it would “reduce our reliance
on the legal system,” suing patients only if their household income
is more than 400% of the federal poverty level, or $103,000 for a family of
four. It also pledged to increase discounts for the uninsured and upgrade its
financial assistance for patients.
Those
measures are “a first step,” it said. On Oct. 28, it named an advisory council
of community leaders, patient advocates and UVA students and staff to consider
further changes.
“We are
continuing to thoughtfully review our billing and collection practices to find
additional ways to better serve our patient as well as improve fairness and
transparency,” said UVA Health spokesman Eric Swensen. “We are looking at all
options to achieve these goals.”
Virginia
Gov. Ralph Northam, who oversees the state’s university system and public
hospitals, is a pediatric neurologist.
“As a
doctor himself, Gov. Northam agrees with the doctors who have taken a stand
against unfair and aggressive medical billing practices,” his spokeswoman said.
“Much more can and should be done to address this issue.”
KHN’s
report prompted discussions across the campus in Charlottesville about how to
treat uninsured patients or those with coverage who still struggle with
thousands of dollars in out-of-pocket expenses, doctors and faculty said.
“No
physician wants to be responsible for bankrupting a patient — not one
physician, not one patient,” said Dr. Mohan Nadkarni, UVA’s chief of general
internal medicine. He is the only physician on the advisory council.
“UVA
physicians were completely taken aback by the scale and magnitude of the
collections practices,” Nadkarni said. Discussion at the council’s first
meeting reflected “lots of pent-up dissatisfaction from community leaders”
about UVA’s practices, he said.
But
many knew the health system was suing patients, they said. Some had firsthand
experience with aggressive tactics from the billing office.
At one
“town meeting” of health system employees, held at UVA’s Leonard Sandridge
Auditorium in response to KHN’s report, somebody took the mic and asked, “Who
in this room has been taken to collections by UVA?” said Matthew Gillikin, a
speech therapist who was there. A quarter to a third of the people raised their
hands, he said.
Court
data analyzed by KHN showed that UVA Health was suing about 100 of its
employees every year.
Also at
the town meetings, “we heard many agonizing stories of patients and employees
having been sued or having wages garnished,” Nadkarni said. “We heard loud and
clear from many physicians that they heavily supported significant
liberalization” of UVA Health’s financial assistance policies.
Family
physician Dr. Alex Salomon, who worked at UVA for seven years and now is with
Augusta Health in Fishersville, Va., had “a lot of patients” with UVA bill and
lawsuit problems, many who had insurance but could not make out-of-pocket
payments, he said. Still, he added, “I didn’t realize UVA was so much worse”
than other hospitals.
As part
of the University of Virginia, UVA Health is a state institution that is not
subject to taxation. UVA Medical Center, the system’s flagship hospital, made a $91 million operating profit
on revenue of $1.8 billion in the fiscal year ending in June and held stocks,
bonds and other investments worth about $1 billion.
Doctors
are realizing that financial barriers to treatment and budget squeezes from
bills can be as harmful to patients as disease, said Dr. Marty Makary, a
surgeon and researcher at Johns Hopkins Medicine who studies hospital debt
collection and is urging UVA alumni to press for further change.
“I have
not talked to a single patient or student of UVA or faculty member or alumni
who thinks it is reasonable for the hospital to sue patients who cannot afford
their bill,” he said.
News of
UVA collections practices served as a teaching moment for at least one class.
“Many
of the students in my class work for the UVA Health System, so the recent media
coverage about UVA’s billing practices has been painful for them as nurses who
care deeply about the patients and families they serve,” Kimberly Acquaviva, a
professor who teaches health policy at UVA’s nursing school, tweeted in
September. “As a class, we talked about the power that nurses have to shape the
lives of the patients and families” by advocating for system change, she said.
She
declined a request for an interview, as did five other doctors or professors.
Several referred a reporter to UVA spokesman Swensen. About 20 others did not
respond to interview requests.
Dr.
Chris Ghaemmaghami, an emergency and internal medicine doctor, became UVA
Health’s acting CEO after Pamela Sutton-Wallace announced her resignation in
September. Her departure was unrelated to KHN’s revelations, UVA said at the
time.
“I
understand the disappointment some fellow physicians felt when our historic
billing and collection practices came to light,” he said in an email responding
to questions from KHN.
Heysell,
Williams and Dillingham, the doctors who wrote the letter, go further.
“To be
clear, we are outraged,” they write. “We stand with those that have been
financially injured, whose bank accounts have been looted, whose homes have
been swallowed as if they were built on quicksand, whose credit scores were
ruined, and whose mental health and energy were spent in a courtroom or in
anxious conversations with lawyers — all as a result of having sought our
care.”
https://khn.org/news/uva-doctors-decry-aggressive-billing-practices-by-their-own-hospital/?utm_campaign=KHN%3A%20Topic-based&utm_source=hs_email&utm_medium=email&utm_content=80694732&_hsenc=p2ANqtz-8hw8iVKXvYiTpxEKHgOt7q5NNObHBBkmfVHbOrfMJUyM9tlStSH_EkhSaowuTOHFZDETJJNSlTK8lr1hAhG6Iifq6e3w&_hsmi=80694732
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