Fairview Hospitals Had

Fair Warning About

Money-hungry Tactics

From the Star-Tribune:

'Money-hungry' tactics raised alarms at Fairview

Fairview employees complained about the new approach to collecting money soon after Accretive arrived.

Just months after a consulting firm swept into the Fairview system with a new approach to collecting money from patients, hospital employees were expressing alarm and frustration, records show.

"We are giving the image that we are money-hungry," one said. Said another: "The patients are being bombarded by phone calls."

Their concerns soon would spread.

In the past few weeks, Fairview and its consulting firm, Accretive Health, have faced an outpouring of criticism over high-pressure tactics exposed in an April 24 report by Minnesota Attorney General Lori Swanson.

But internal documents, including hundreds of private e-mails, show that warning signs were mounting soon after Accretive arrived in early 2010.
The documents included in Swanson's six-volume report illustrate a behind-the-scenes struggle after Accretive was given nearly total control over the hospitals' revenue collection. They also reveal that hospital officials were voicing serious doubts about Accretive's competence and tactics long before Fairview cut its ties to the firm last month.

Accretive defends its record, accusing Swanson of distorting the facts and saying it strives to help patients understand and manage their hospital bills. It approaches patients with compassion, it says, and "never in a way that interferes with timely care.''

Fairview, meanwhile, has acknowledged making mistakes. "We know that [some] patients did not have the experience they deserve,'' Fairview said in a written statement. "Our message to them is this: We're sorry. We know we have work to do to restore faith and trust in our organization."

Financial pressures

In July 2010, an Accretive consultant named Brandon Webb was clearly unhappy with collections at Fairview Southdale Hospital. "If these are truly our numbers, we have a lot of work to do," he wrote in an e-mail.

It was just three months into a new era at Fairview.

Fairview had hired Accretive, a Chicago consulting firm, in March 2010 to help reduce its hospitals' bad debts -- the amount patients owed but never paid. Like hospitals everywhere, Fairview was under pressure from a weak economy and a changing insurance landscape that leaves patients with higher shares of their bills.

Records show Fairview's hospital bad debt had actually been falling since 2006, to one of the lowest rates among Twin Cities hospitals -- roughly 1.5 percent of operating expenses.

But Fairview CEO Mark Eustis, who had come on board in 2007, said he believed Accretive could do a better job.

Accretive quickly rolled out a new initiative. Hospital employees were told to check all incoming patients to see if they had a prior balance, or unpaid debt -- and if so, press them to settle up on arrival.

Hospital employees struggled with the new rules, the e-mails show, and managers weren't pleased.

"These numbers look awful this month," wrote Webb, the Accretive "site lead" at Southdale and Ridges hospitals.

"It's noon, and we are only at $5,000," wrote Jena Anderberg, a Fairview business services director, in October.

By then, Accretive, which was given the power to hire and fire hospital employees, was taking a hard line. "We've started firing people that aren't getting with the program," wrote Accretive's Andrew Crook to Fairview executives in September 2010.

Swanson later said Accretive's arrival set off "culture wars" within the hospitals, and by September 2010, an employee survey bore that out.

Asked how they felt about collecting money from patients arriving at the hospital, 35 percent said they were comfortable with it; 40 percent said they weren't.

"Let's face it, sometimes when people are in crisis the last thing they are thinking about [is] the cost," one said. "I realize that times have changed, but are we pushing the envelope too much?"

In November 2010, complaints were filing in from patients and staff members.

One administrator complained that financial counseling at the bedside was "holding up his rooms" in the emergency department, and suggested that it wait until the patient was discharged. Anderberg replied: "I have tried that model at Southdale and we lost hundreds of thousands of dollars in patients walking out the front door."

Meanwhile, Fairview officials were strengthening their ties to Accretive.

In November 2010, they announced that Fairview would become Accretive's first client in an ambitious new venture aimed at improving quality and lowering costs. Mary Tolan, Accretive's CEO, predicted it could cut Fairview's costs by 25 percent, nearly half a billion dollars, in five years.

But Accretive's revenue consultants were still searching for ways to boost their numbers. They offered gift cards, trophies and $40 bonuses to hospital employees who collected the most.

The new rules weren't just about collecting old debts. They also sought payments from patients with no prior balances, to cover co-pays or deductibles before treatment.

'Poetry'

By mid-2011, e-mails suggest that more patients were being approached for payment. Accretive's Bruce Frank singled out one employee who collected $1,875 from a patient. "I witnessed the entire event," he wrote on June 3, 2011, "and it was like poetry."

Some of the motivational tactics appeared to trouble Fairview officials. CFO Daniel Fromm objected to awarding gift cards to top collectors: "Do you also understand that this practice violates our corporate policy?"

In August 2011, Fairview official Joline Storla asked Accretive to stop posting employee names with the amounts they collected, saying it "may cross some HR [human resources]" line. Accretive's Peter van Riper replied that it was "critical for improving performance, and so we'll continue with it as-is."

In May of last year, an internal Fairview audit raised even more concerns -- that Accretive was violating the terms of a 2005 agreement with then-Attorney General Mike Hatch. The agreement set out rules to protect patients from overly aggressive debt collectors.

Fairview officials warned Accretive in September, October and November that it was still breaking those rules, documents show. In November, an internal Fairview review said Accretive had placed the hospitals at risk "due to ignorance of the AG agreement."

Fromm, the CFO, told the Star Tribune that Fairview took action as soon as those problems surfaced, including hiring an outside consultant to study why morale was declining under Accretive.

In January 2012, Fairview dropped Accretive as its debt collector; last month it cut all remaining ties.

Last year, in spite of Accretive's efforts, Fairview's bad debts rose by almost 45 percent, to $58.1 million. Fairview blamed several factors, including accounting changes, a soft economy and "increasing difficulty" in collecting the patients' share of the bills.

Today, Fairview officials say, they are making changes. "We're listening to our employees and patients and using this feedback to guide us in our actions."

Comments on the article:

I won't be using Fairview anytime soon.

Careful, Strib. You don't want Rahm Emmanuel up in your grille, do you? I never thought anyone could make Allina look good, but Accretive, my hat is off to you--you've done it!

 Letting a vendor make hiring/firing decisions? Offspring of board members employed by Accretive, while board members also had stock in Accretive? This was a total abdication of management by Fairview administration. And everybody in leadership still has their jobs?

Here is a thought, stop spending money on consultants like a teenager with daddy's credit card. That should save SOME of the money you are worried about collecting.

Thanks once again to the best AG Minnesota has ever had. She has our back on main street. Keep up the good work for all Minnesotans.

It's situations like this - as well as issues with ethical complaints against surgeon Dr. David Polly - that make me glad that I no longer work for Fairview. Eustis and the rest of the senior management are driven by money, not philanthropic will and patient care, as they like to claim.

In regards to patient care, I was terminated from the University of Minnesota Medical Center, Fairview because I had the nerve to ask the entity safety officer about some concerns I had regarding issues that the surgical department management team wasn't addressing, i.e. people in street clothes being allowed into sterile areas that required surgical attire (hospital laundered scrubs and hair restraints.)

In the meantime, I hope Fairview and Accretive get throttled for their wicked administrative practices. isn't bad enough to be sick?

This story seems more like a highly-satirical Mike Judge movie than reality. Accretive seems like a bunch of heartless idiots, and the judgement of Fairview's board members was unforgivable in hiring them and exposing its patients and employees to such a poisonous environment. I am going to make every effort to steer clear of Fairview at all costs.

 I showed up for surgery at Fairview Southdale last year, nervous and in pain, only to be threatened with surgery cancellation if I did not pay $1000 on the spot. Stunned, I payed it...not knowing if the amount was correct. I was also told that there was an outstanding balance from 2 years prior but when I called after surgery to correct the debt I was told it was an error and my account never was owing. After reading this, I will check my records to make sure Fairview did not overcharge. And I will always have second thoughts about going to a hospital where I am basically threatened when I am most vulnerable.

Geez...you really get to wondering what else has or is going on over there. With all the exposure the past few years regarding how patients were being coerced into psychiatric clinical trials and the never ending stories about doctors and conflict of interest and now all this. No amount of apologies from Fairview can excuse this mess. Pathetic.

 Wow, no mention whatsoever in this article of the family members of Fairview executives who are executives at Accretive?

So now the Accretive emails come out...I can't wait for Accretive's response!

And why did Fairview go outside of Minnesota to hire bill collectors?

I've stopped contributing to the Fairview Foundation until I see heads of VP's rolling out of the front doors of Fairview HQ.

This information is what Accretive was using Rahm Emmanuel to keep under the rug. Credit goes to Fariview staff putting information into the record and Attorney General Lori Swanson knowing what a pig looked like - even with lipstick.

I sincerely hope that Fairview will apply this "collection policy" on the day soon to come when Mark Eustis is removed from his CEO office and escorted out of the corporate office building. When that day comes, perhaps they can dispatch an Accretive employee to make sure that he has repaid his executive loans and turned in the keys to his company-leased vehicle.

Fairview is cutting the number of Drs at their clinics, and I've been told to pay an "outstanding" balance in order to be seen at my next appointment. When I told the person that the "outstanding" balance had been sent to my insurance company with the wrong code, she told me "no, it was coded correctly, they wouldn't pay it, you need to pay it to be seen." I walked out of the clinic.

 Stay away from Fairview Hospitals, Clinics and Associated Networks due to its conduct towards employees, lack of human decency for those in difficult times and compromising of clean areas by bill-sharks chasing quotas.

I just hope that the members of the Fairview Board of Directors take the time to read these comments so they will see they have a long ways to go to make up for the lack of judgement exhibited by the leadership of the organization. The public's perception of Fairview is down the tubes and unless they show there is more than just an "I'm sorry" attitude, they won't have to worry about collecting fees because Allina will be getting the money.

 Fairview executives responsible for this need to be fired.

  BTW, giving this Accretive company the power to fire people is just crazy! The people who decided to allow that MUST be fired and without their golden parachutes too.

"Our message to them is this: We're sorry. We know we have work to do to restore faith and trust in our organization."

You're sorry you got caught. Staff and patients spent years telling management what was wrong with the new system, yet they have to do an employee survey and hire an outside consultant to tell them why morale is tanking. It doesn't take a brain surgeon to figure this one out.

Despite their 'see no evil' attitude towards their oversight responsibilities, the Fairview board needs to take disciplinary action towards those top executives who abused the community's trust by their failure to understand the ethical concerns associated with allowing vendors to hire family members.