The Holy Grail for Medical Records


It’s only a matter of days before a milestone in US health care.

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

The rule prohibits providers from hoarding records and is intended to make it easier to switch doctors and help specialists keep up to date with the condition of their patients.

In some corners of the Twitterverse, it’s cause for celebration.

But setting a deadline and forcing organizations to comply with it are two different things.

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

There is also debate over whether healthcare providers refuse to share records.

And then there is the execution. A rule without penalties, and with multiple exceptions, is not really a rule, according to some.

It’s where we explore the ideas and innovators that are shaping healthcare. The Atlantic’s Ed Yong is going on sabbatical after three years of covering Covid-19. He says the pandemic broke him and honestly, we get it. Read his pandemic coda here.

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A massive network of nonprofit hospitals, driven by one of America’s most prestigious management consulting firms, was hunting down indigent patients for money.

This is a story told by New York Times investigative reporters Jessica Silver-Greenberg and Katie Thomas, this explains why many low-income people, especially people of color, are hesitant to seek treatment.

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

Additionally, state laws require the Providence chain to provide free care to low-income patients.

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

An employee of a minimum-wage dental practice sought treatment for a headache and nausea at a facility in Providence, California, Orange County. The hospital sent a debt collection agency after him for $4,394.45.

An elderly person in Everett, Washington, on Medicare, his only income being a federal disability allowance, sought care for diabetes complications. After the hospital demanded payment, she reduced her food and heating to pay the medical bill.

The story ended: Many “nonprofit hospitals have become virtually indistinguishable from for-profit enterprises, embracing a relentless focus on the bottom line and deviating from their traditional charitable missions.”

In Providence’s case, management consultancy McKinsey & Company, to which the hospital network paid at least $45 million in 2019, devised the tactic.

Gregory Hoffman, CFO of Providence, told The Times that the paper’s findings were “very concerning.” Providence stopped referring Medicaid patients to collection agents and asked its collection agencies to stop garnishing wages or referring people to credit reporting agencies.

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

Evans and McGinty pointed out that billing practices vary widely. Hospitals in Wisconsin, for example, had “sued patients for medical debt at a rate that equates to one in 1,000 residents per year, especially people living in low-income areas who are black.”

The government gets involved: Journal of Health Insurance reporter Anna Wilde Mathews examined the public policy response in another article that preceded the Times take. Matthew found this 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 low-income people or to limit aggressive debt collection practices.”

Why is this important: 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 has medical debt, with people of color most likely to owe money. She wrote: “Medical bills are the main source of debts in collection, greater than all the other types of debt combined.

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

Mathews asked for a response from the American Hospital Association, which said its members had provided “more than $700 billion in unpaid care since 2000.”


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