The holy grail for medical records

Sep 30, 2022

By Ben Leonard, Ruth Reader and Carmen Paun

TWEET STORM

It's just a matter of days before a U.S. health care milestone.

That's the Oct. 6 deadline the Health and Human Services Department set for providers to ensure medical records follow patients from provider to provider.

The rule bars providers from hoarding records and aims to make it easy to switch doctors and help specialists get up to speed on their patients' conditions.

In some corners of the Twitterverse, that's cause for celebration.

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But setting a deadline and getting organizations to comply are different things.

As Ben reported earlier this week, the American Hospital Association and the American Medical Association, which represents doctors, asked for more time. They cited technical challenges and misaligned compliance deadlines HHS set for their technology vendors.

There's also a debate about whether health care providers are refusing to share records.

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And then there's enforcement. A rule without penalties, and with multiple exceptions, isn't much of a rule, some argue.

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WELCOME TO FUTURE PULSE

This is where we explore the ideas and innovators shaping health care. The Atlantic's Ed Yong is going on sabbatical after three years covering Covid-19. He says the pandemic broke him and honestly we get it. Read his pandemic coda here.

Share news, tips and feedback with Ben at bleonard@politico.com , Ruth at rreader@politico.com or Carmen at cpaun@politico.com.

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WEEKEND READ

A Providence hospital in California | Getty Images

A major nonprofit hospital network, urged on by one of America's most prestigious management consulting firms, hounded indigent patients for money.

It's a tale laid out by New York Times investigative reporters Jessica Silver-Greenberg and Katie Thomas, that explains why many low-income people, especially people of color, are reluctant to seek medical care.

Experts believe disparities in health outcomes have roots in how we pay for medical care and the hardball tactics some providers use to get patients to pay up.

What's more, state laws require the chain, Providence, to provide free care to low-income patients.

The details: A fast-food restaurant manager on Medicaid gave birth to a gravely ill premature baby at a Providence hospital in Anchorage, Alaska. Before she was discharged — and after her son died — a hospital employee confronted her with a bill.

A dental office worker making minimum wage sought care for a headache and nausea at an Orange County, Calif., Providence facility. The hospital sent a debt collection agency after him for $4,394.45.

A senior citizen in Everett, Wash., on Medicare, her only income a federal disability stipend, sought care for complications from diabetes. After the hospital demanded payment, she cut back on food and heat to pay the medical bil.

The story concluded: Many nonprofit "hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions."

In Providence's case, the management consulting firm McKinsey & Company, which the hospital network paid at least $45 million in 2019, devised the tactics.

"How would you like to pay that today?"

-- McKinsey & Co. provided exact wording on how Providence hospital bill collectors should ask for payment.

Gregory Hoffman, Providence's chief financial officer, told the Times the paper's findings were "very concerning." Providence has stopped referring Medicaid patients to debt collectors and asked its collection agencies to stop garnishing wages or referring people to credit agencies.

A growing story: Last year, Wall Street Journal reporters Melanie Evans and Tom McGinty highlighted a study in "Health Affairs" that "found some hospitals were more likely than others to take patients to court and low-income and Black patients were disproportionately sued."

Evans and McGinty pointed out that billing practices varied widely. Hospitals in Wisconsin, for instance, had "sued patients over medical debt at a rate that amounts to one out of every 1,000 residents a year, especially people in low-income areas and who are Black."

Government gets involved: Journal health insurance reporter Anna Wilde Mathews looked at the public policy response in another piece that preceded the Times' take. Mathews found that at least 10 states, including Connecticut, Maryland, New Mexico and Maine, have recently enacted laws to protect patients.

The laws differ, but some include "requirements for hospitals to provide financial assistance to people with low incomes or limit aggressive debt-collection practices."

Why it matters: Mathews pointed out that hospital prices vary wildly and uninsured patients are often charged the highest amounts.

She noted that nearly one in five U.S. households have medical debt, with people of color most likely to owe money. She wrote: " Medical bills are the biggest source of debt in collections, larger than all other types of debt combined."

Yes, but: In their Times piece, Silver-Greenberg and Thomas cited Providence's more-than-$27 billion in revenue last year but noted in a parenthetical that the hospital is losing money so far this year. The hospital chain ramped up collections, they wrote, to balance "hundreds of millions of dollars" it spent providing free care to patients who couldn't pay.

Mathews sought a response from the American Hospital Association, which said its members had provided "more than $700 billion in uncompensated care since 2000."

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