Erlanger hospital has chalked up a $17 million operating deficit in the past 10 months, but it is hardly alone in its current financial struggle to stem red ink and restore fiscal balance. Hospitals across the country, large and small, have fallen into a fiscal trough due primarily to at least two broad issues.
One is the decline of voluntary surgeries in the hangover of the 2007 recession in lost jobs, stagnant wages and higher insurance deductibles and cost-share formulas. Another is the rising number of indigent patients who have lost jobs or can't afford coverage, but who still don't meet the poverty guidelines for Medicaid/TennCare, and who turn to emergency room visits for conditions that hospitals are required by federal law to treat.
These dire circumstances, to be sure, are further propelled by other pernicious inter-linked trends -- excessive rises in medical costs, increasing numbers of underinsured and uninsured families, and the rising proportion of personal bankruptcies due to unaffordable medical-related debts.
These broadly prevailing conditions are self-evident grounds to embrace health care reform and the Affordable Care Act. Conversely, they also underscore the question of what Republican opponents of the ACA would offer as a viable alternative remedy to the nation's irrefutably dysfunctional health care system.
But while Republicans still won't say what they would put in place of the ACA to bring the profit-driven medical care industry in line with the needs of the nation for an affordable health care model, the industry is becoming more avaricious. It's well known for example, that the pharmaceutical industry, which is required to negotiate drug prices with national universal health care systems in most other industrialized countries, is allowed to continue to make the bulk of its profits in the United States.
A new case in point is the finding of a Minnesota attorney general that the one of the nation's largest collection agencies for unpaid medical care debts has been allowed by client hospitals to embed and mingle debt collectors indistinguishably among employees, and to allow them to badger and intimidate patients for payment before and while care is rendered. Acting on the possibility that the collection company, Accretive Health, may be using similar practices at hospitals in other states, The New York Times reported last week, the attorney general had entered discussions with state and federal officials about how to proceed with a coordinated response to the company's practices.
The Minnesota attorney general, Lori Swanson, found that patients were wrongly dunned by debt collectors at their bedside both before and after treatments, The Times reported. The debt collectors also may have gained illegal access to patients' health care records, and may not have revealed themselves as debt collectors, as law requires. They are also alleged to have intimidated some patients by suggesting or warning that care might be withheld if they did not agree to payment requirements.
Such alleged actions, if accurate, would violate legal requirements for hospitals to render emergency care, and legal standards that govern debt collectors' activities.
Given the risk of hospitals across the country accumulating unaffordable deficits and being driven out of business, it seems obvious that denying the need for reform and keeping the present status quo is an untenable position. Reforms are necessary across the industry to reduce costs for medicines and medical devices, to improve preventive care, to scrap the fee-for-itemized-services model, to broaden the base of insured citizens, to standardize medical records systems and to reduce the costly adversarial industry of negotiating insurance claims.
If reform is thwarted and hospitals can be induced to let debt collectors determine who gets emergency care, the nation's legal and moral commitment to providing the most minimal care will be broken. That's not just a chilling thought. It's a Darwinian path to death this nation can ill afford.