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Transparency guideline for collecting patient payments, Willmar, Minn.'s, Rice Hospital says

WILLMAR -- Transparency is Rice Memorial Hospital's guideline for collecting payment from patients for the care they receive, hospital officials says.

It's a message they reiterated this week in the wake of allegations that Accretive Health Inc., a medical consulting firm from Illinois, used high-pressure tactics to collect from patients at some Twin Cities hospitals.

The Minnesota Attorney General's office has filed a lawsuit against Accretive, and Fairview Health Systems severed its ties last week with the company. Accretive has disputed the allegations.

The issue has focused renewed attention on how hospitals collect from patients and the strategies they use for doing so.

Hospitals historically haven't emphasized paying the bill, said Mike Schramm, chief executive of Rice Hospital. This is changing, however, and "it's something new the public has had to get used to," he said.

But there's a fine line between asking patients to pay and pressuring them, he said. "I think the difference is the process and the way we go about it. We try to be proactive with this."

Late in 2010 Rice began collecting co-pays and deductibles up front from patients and providing estimates of the bill ahead of time. This has gradually been widened and now includes the emergency room and labor and delivery as well as outpatient care.

All of this is done with internal staff, Rice officials said. For those who have difficulty paying, staff helps set up a payment plan or connects them with a source of charity care.

"We are allowing them to pay up front and identifying patients in need of help," said Jackie Hinderks, director of revenue and reimbursement. "I think the key here is that we're being transparent with patients. ... We're not debt collectors."

In the emergency room, where patients and families often are highly vulnerable, "we are only collecting co-pays at this time," she said. "We are not pushing it by any means."

Bad debt remains low at Rice, amounting to 1 percent or less of annual charges. The hospital uses a couple of debt collection agencies but doesn't turn over unpaid bills until internal attempts to collect have been exhausted, officials said.

For the past several years Rice also has had an agreement in place with the Minnesota Attorney General's office that outlines acceptable debt collection practices and requires the hospital to track complaints.

Complaints have been few, said Bill Fenske, chief financial officer.

Patients have been receptive to the hospital's new practice of asking up front for their out-of-pocket share of the bill and providing an estimate, he said. "We have had a lot of positive feedback from people. That was the reaffirmation we had that we're going down the right road."

If reaction had been negative, "we would definitely have re-examined it and made changes," he said.

Hospital officials said there's ongoing training for staff to ensure they have the right skills for dealing with patient finances. Staff also is monitored "to make sure we're doing things appropriately," Fenske said.

The lawsuit against Accretive prompted yet another look last week at Rice's processes for any sign of trouble.

"Anytime something like this comes up, you're always looking at your process," Schramm said. "We believe we're approaching it in the right way. If things need to be tweaked or changed, we're going to look at that."

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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