Report blasts Tacoma’s MultiCare for ‘traumatic’ and ‘aggressive’ billing and collections

Carmelita Swain’s kids play a lot of sports, so X-rays are a part of life.

What the Tacoma woman didn’t expect was for someone from MultiCare to call her just a week after her two sons were treated at Mary Bridge Children’s Hospital and demand immediate payment of the $3,000 bill or it would be sent to collections.

“I have Tricare,” Swain said Wednesday, referring to the insurance she receives through the U.S. military as a retired Army medic. MultiCare “told me it wasn’t covered and I had to pay the bill that day.”

Swain’s story was one of a handful featured in a critical report issued Wednesday by Washington CAN, a community organization. The report focuses on two aspects of MultiCare’s collections: “traumatic” point-of-service billing — collecting payment from patients while they’re still in the hospital for treatment — and of “aggressively” garnishing wages and charging unreasonably high interest on medical debt.

MultiCare CEO Bill Robertson said he could not comment on the specifics of Swain’s situation, but that the nonprofit health system doesn’t refer bills to collection until it has sent four bills and made three phone calls over a period of about 120 days.

“That’s baked into our process,” he said. And while he hadn’t seen Washington CAN’s report, he said MultiCare is “always open to being better at what we do.”

MultiCare Health Systems is Pierce County’s largest private employer. It operates five hospitals, 26 primary care clinics and 10 urgent care centers, primarily in Pierce County and South King County. Last fall, it announced plans to cut $300 million in expenses over three years.

MultiCare has not recorded a loss in 10 years, a spokeswoman said last fall. It is profitable — in fact, 2012 was its most profitable year, when it recorded an operating margin of $207 million.

Washington CAN says MultiCare’s drive for profits has taken precedence over caring for the community.

“More people have health insurance than ever,” said Will Pittz, executive director of Washington CAN. “There’s no reason for low-income people to be this aggressively pursued.”

Some of MultiCare’s collection practices came to light last year as part of a lawsuit over improperly filed medical liens. The health system settled the lawsuit last year for $7.5 million. In light of the actions revealed by that lawsuit, a state lawmaker from Tacoma has proposed tightening some aspects of state law. Last week, The News Tribune reported that a Pierce County woman is suing MultiCare, accusing its vendor of charging illegal and excessive fees for providing copies of medical records.

Robertson said MultiCare has a duty to ensure its own financial viability.

“We are really seeking to do what’s in the best interest of our community, and that’s not just giving away all the care for free,” he said. “This community needs a health system that will be around for another 133 years. And we have to be equitable to those who do pay their bills.”

Washington CAN, in its report, says MultiCare has so refined its process for collecting payment that it approaches people “even at the patient’s bedside” for estimated charges, co-pays and deductibles.

The health system’s “patient access technicians” are evaluated and provided incentives to increase these “point-of-service” collections, the report says. This pressure to collect has led to incidents that include, according to the report, collecting payment from a patient who was beginning to be treated for heart problems.

Robertson said any attempt to collect payment is supposed to come at the end of the visit, after the medical situation is over. Collecting payment at the time of service happens everywhere, he said, not just the hospital.

“We buy groceries, and we pay when we check out. Go to a sports event, and you have to pay before you get in,” he said. “The reason we do that is because the likelihood of being paid what we are owed for the service we provide is much greater the earlier we make the ask.”

Another target of Washington CAN is MultiCare’s efforts to collect payments through the court system and wage garnishment. The community organization said it analyzed a random sample of 100 collections cases filed on behalf of MultiCare in Pierce County Superior Court and found that patients face an average of $3,400 in interest and legal fees in addition to whatever they owed for the original medical bill.

The eight-page report recommends MultiCare have its collections activities and vendors overseen by an “independent, community-based committee with the power to make changes in collections protocols and respond to complaints.” It also suggests MultiCare reduce the interest rates it adds to medical debts, which are legal under state law but higher than those in other states.

For example, Pittz said, Oregon allows an interest rate of no more than 9 percent. In Washington, it’s 12 percent, and he said MultiCare charges 12 percent in every case.

“We are committed to living within what the law provides,” Robertson said. Any change in the interest rate would need to come from the Legislature, he said.

Robertson said MultiCare has many financial assistance programs, including one that used to be referred to as “charity care” that was revamped last year.

Under the new program, MultiCare will write off 100 percent of any portion of the bill not covered by insurance for people whose annual income is 300 percent or less of the federal poverty level. For a family of four, that translates to an annual income of $72,750. Other income levels can qualify on a sliding scale.

But to get that assistance, Robertson said, people have to participate.

“Many times we get to garnishment because (people) haven’t responded to requests to participate in a financial assistance program or enrolling in Medicaid,” he said.

Robertson also made no apologies for being pro-active in contacting people.

“We are held to a high standard by state and federal regulations for having pro-active communication and practices,” he said. “Many people might want to receive no phone calls. The flip side is, if you don’t call until the bill is about to be sent to collections, people say, ‘you never called me.’ ”

Pittz of Washington CAN said MultiCare and other hospitals need to refocus their efforts on people.

“We need to raise the bar in how hospitals treat low-income patients — not in terms of care, but in terms of debt,” he said. “Whatever medical emergency sent them to the hospital should be the extent of their trouble.”