Hospital company sued after FCC tightens medical debt collection rules


The bar was raised for medical debt collectors last summer when the Federal Communications Commission issued a ruling that made it harder to dial patients on their cellphones without their express consent.

Now a California-based hospital chain has become one of the first providers to be sued since the FCC’s July interpretive ruling.

The class-action suit targets Prospect Medical Group’s Southern California Hospital at Culver City. It alleges that the hospital used an automated dialer to call patient Donna Ratliff on her cellphone in order to collect a debt and did not have her express consent to do so.

The FCC issued its interpretive ruling after the medical debt collection industry—hoping for more flexibility—asked for greater clarification on the decades-old Telephone Consumer Protection Act to address issues such as auto-dialing cellphones, consent to call and reaching wrong numbers.

Instead, the FCC made it clear that debt collectors need express consent before dialing a cellphone and gave little leeway for when they reach a number that’s been reassigned.

Prospect Medical declined to comment on the Ratliff case, stating that the company hasn’t yet been served with the complaint.

However, the company insisted in a statement that it follows the necessary practices to obtain consent to call patients on their cellphones. “All of our patients are asked to sign an irrevocable authorization permitting our hospitals to contact them via telephone—including, specifically, via cellphone—in their efforts to collect outstanding debt.”

The plaintiff’s exact argument is still unclear, said Justin Kay, a Chicago-based attorney at law firm Drinker Biddle, who described the suit as “threadbare,” perhaps to make it harder for Prospect to win a motion to dismiss. “Presumably, what (the plaintiff’s attorney) is going to argue is the scope of consent did not include this call based on the circumstances under which the number was provided,” he said.

Previous cases have generally given hospitals some latitude on calling patients for purposes of collecting a payment as part of an episode of care. But healthcare providers need to make sure that the debt is linked to the medical encounter during which the patient provided a cell number.

“The best practice for any hospital is to have written consent during the admissions process that is broadly worded to include all types of automated calls and texts,” said Bradley Andreozzi, a Chicago-based attorney at Drinker Biddle.

TCPA violations are already an active area for plaintiffs, with TCPA-related lawsuits increasing 560% between 2010 and 2014, according to ACA International, the Association of Credit and Collection Professionals.

“As the FCC gradually narrowed the scope of express consent, it became cause to litigate,” Andreozzi said. “We don’t see any sign that that’s going to change anytime soon.”

Penalties for TCPA infractions start at $500 per call and can reach as much as $1,500 for willful violations.

While the Prospect case deals with the issue of express consent, it doesn’t touch one of the thorniest and most controversial parts of the FCC’s recent ruling: what happens when a debt collector reaches someone in error. The FCC allows medical debt collectors to call a number just once without penalty, regardless of whether someone picks up.

“The problem is they left no room for the situation—and this is increasingly common—where the person doesn’t answer the phone,” said Lewis Wiener, a Washington-based attorney at law firm Sutherland, Asbill & Brennan. “You’ve put them in an impossible situation.”

As many as 100,000 cellphone numbers are reassigned everyday, Wiener added.

ACA International has sued the FCC challenging the July order.

“It’s impossible for companies to keep up with that level of risk factor,” Wiener said. “There’s really no way to confirm whether the person you’re calling is the right number. It’s a gotcha.”

The best ways for providers to protect themselves, Wiener said, is to have a rigorous process for getting consent, respect the wishes of people who opt out and, whenever possible, use e-mail. “You’re swimming in shark-infested waters,” he said. “Take as few laps as you can.”

2015 Healthcare Workforce Executive Insights Survey Results

To gain a better understanding of how healthcare industry changes have affected talent management practices, HealthcareSource and the American Society for Healthcare Human Resources Administration (ASHHRA) issued the 2015 Healthcare Workforce Executive Insights Survey. 

More than 400 people at healthcare providers across the country offered their views about how their talent management organizations are adapting to industry changes such as aging demographics, population health, accountable care initiatives, and the rapid growth of retail care clinics.

Check out our infographic for a breakdown of a few key data points.


2015 Healthcare Workforce Executive Insights Survey - HealthcareSource and ASHHRA

MedAssets deal could pave way for regional and provider-led GPOs


The VHA-UHC Alliance’s planned acquisition of MedAssets’ group purchasing organizations and consulting business will make health systems reconsider their GPO allegiances and open up the market to disruptive models, experts and industry insiders say.

Consultants, as well as former and current GPO executives, say the deal could push providers toward smaller, regional GPOs that focus on local sourcing and niches. The mega-GPO created from the merger could lose members who are uncomfortable with the GPO’s size and changes that may come after integrating the two companies.

MedAssets announced Monday that it had been acquired by Pamplona Capital Management for $2.7 billion, which would immediately sell its spend and clinical resource management segment to VHA-UHC for an undisclosed price. Pamplona said it would integrate MedAssets’ remaining revenue-cycle management business with Precyse, its own revenue-cycle software.

Several consultants expressed concern that VHA-UHC could become disorganized as it works to integrate yet another major acquisition. The company has said it would announce a new name in the coming weeks, as it continues to integrate the operations of VHA, a major not-for-profit hospital GPO, and UHC, an alliance of most of the nation’s academic medical centers. The merger between the two closed in April.

To make matters more confusing, MedAssets hasn’t quite integrated the culture of Broadlane Group after acquiring its former rival in 2010 for $850 million, said former Broadlane CEO David Ricker, who is now CEO of BroadJump, a developer of software that helps hospitals manage their costs and see what others are paying for supplies. Some former Broadlane members liked the GPO’s stricter, more-committed model instead of MedAssets’ more flexible models that let hospitals use other vendors, he said.

“You’ve got former Broadlane clients still with MedAssets who were still pushing very hard to get to that Broadlane model,” Ricker said, adding that those hospitals may not wait to see what VHA-UHC decides to do next.

Dallas-based Tenet Healthcare Corp., a former member and majority owner of Broadlane, announced earlier this year that it wouldn’t renew its MedAssets contract. It chose to sign a five-year contract with HealthTrust, a committed-model owned by HCA. Experts said Tenet officials wanted a higher-commitment model in hopes of it leading to better prices.

Former Broadlane executive Brian Pellegrini, now managing director of spend performance consulting at the Advisory Board Company, said he expects HealthTrust executives to go after MedAsset members, especially the legacy Broadlane customers. Those members “are probably going to be the ones with the hardest time seeing a path that makes sense for them to remain with this new organization,” Pellegrini said.

Ricker and Pellegrini said they expect emerging regional GPOs, often developed by health systems, will be winners in this deal. Smaller, regional GPOs tend to pick a niche, such as physician preference items or purchased services, and focus on delivering strong contracts mainly in that space that can supplement a provider’s national GPO.

“Hospitals are going to be a lot smarter about how much their supply cost goes up every year, and savings touted by some of these organizations just aren’t real,” Ricker said. “The only way to get your physician-preference item spend under control is to source locally and regionally, and that’s not what a massive org with (VHA-UHC) and MedAssets is going to accomplish.”

These smaller firms now have a chance to show hospitals executives why it pays to have more than one GPO, said Daniel May, a managing director at Huron Healthcare. He pointed to the Plano-based Texas Purchasing Coalition and Atlanta-based Partners Cooperative that have been successful honing in on certain supply segments, with TPC showing strength in physician-preference items and Partners focusing on commodities.

Ricker, Pellegrini and May all mentioned that provider-led GPOs such as Amerinet, which is owned by Salt Lake City-based Intermountain Healthcare, and HealthTrust could also benefit from the MedAssets fallout. Amerinet CEO Brent Johnson is betting on that too, as he transforms his organization from a traditional GPO to a professional supply-chain organization.

“These people do this to make money,” Johnson said. “Intermountain didn’t. We did it because we trusted that you were going to be a model to the industry, teach us best practices … and we’ll go from there. If down the road people just aren’t willing to get off the administrative fee and the traditional GPO, then maybe our model is wrong, but I don’t think so.”

Johnson fully acknowledged that national GPOs have a hard time adopting the committed model that tends to get the best prices from vendors. He sees customers doing increasingly more on their own and within their respective regions to get more efficient contracts, which is why Amerinet–which will get a new name in 2016–is rolling out consulting solutions and outsourcing services over the next year to help customers manage their supply spend beyond their contracts with the GPO.

“We see ourselves as a very unique alternative rather than being connected to a huge GPO that’s out of touch with service,” Johnson said. “People will understand the importance of total non-labor spend. That isn’t done through a traditional GPO.”

These services will be offered at a lower cost than Amerinet’s competitors and the GPO will charge fewer administrative fees, Johnson said.

As more and more customers look into creating their own regional GPOs, the new Amerinet could help them plan out their administrative fees structure and other complex systems needed to manage it, Johnson said. And if they don’t have the talent or resources to handle some of those processes, they can outsource them to Amerinet.

“We welcome the change (at MedAssets) because we think it adds flux and a lot of confusion in the market that allows us time to build our solution, and I think it builds a lot of uncertainty for a lot of their customers, which allows us to go to people who didn’t want to talk to us before,” Johnson said.

A lot of health systems were already considering their options for switching GPOs before this announcement, said Dr. Mitch Morris, U.S. leader of Deloitte’s providers industry practice. Many of his clients have been stepping back and evaluating what they’re getting from their current GPO relationships.

The new GPO entity created following the merger will have to put together a story of how it will perform even better and drive even greater value, Morris said.

“If I were them, I’d be talking to my customers and reassure them that not only are things not going to get worse, they’re going to get better,” Morris said. The impact as far as lost customers will probably not be felt for years, he added. The scale of the company will be hard to beat in its ability to negotiate better prices because of its volume, “but clients won’t feel very special when they’re a part of something so big,” he said.

MedAssets was successful because it offered an alternative model from some of its competitors, said Doug Pedersen, a managing director at Accenture Strategy who focuses on healthcare.

For example, while VHA-UHC’s Novation GPO and Premier have private drug label brands and lean toward contracts with just one vendor, MedAssets officials have said that they’re against private labeling and that their customers prefer multi-source contracts. VHA-UHC executives have similarly pointed out that MedAssets hasn’t engaged in guaranteed-volume contracts that some believe can prevent drug shortages, a known strategy for Novation.

“It’s up to the purchaser to bring in the value of what you’re buying without breaking it,” Pedersen said. “It wouldn’t be wise to just take their members.


want to have the ability to demonstrate to all of those customers that they have a really good product.”


Eight Ways Physicians Know They’re Overworking


Overwork is not pretty, and in some cultures it’s deadly. In Japan, “karoshi” or death from overwork, annually claims anywhere from 10,000 workers to 30,000 workers. The range is vast because, without autopsies, it’s difficult to accurately assess the cause of death of people at their desks, slumped over.

Karoshi does not appear to be a significant phenomenon in the U.S. Still, among over-workers and the highly fatigued, high blood pressure and heart disease are exceedingly common.

Danger ahead

Given that you work very long hours — why can that be dangerous? When you encounter stressful situations by working longer and harder, your muscles contract, your blood thickens, your heart pumps blood faster, and your arteries narrow. You’re prepared for fight or flight. If you actually did fight or flee, the situation would largely take care of itself.

Instead, your internal “engine” is revving for eight hours to 10 hours on end. You arrive home, where more stressors may emerge. You cannot sleep as many hours as your body requires, or if you do, it’s fitful sleep with tossing and turning. As a result, you’re being worn down and your immune system is becoming weaker. Thus you’re more susceptible to illness.

Some researchers believe that consistently having too little sleep could impact your whole life, to your detriment. Combined with too much work and too little sleep, any illness that you might contract can be more troublesome.

Beyond tired

You feel tired, but when are you bordering on danger? Among many signs, here are a few:

1. Lack of appetite or indigestion. You normally look forward to meals, but when highly fatigued, you have trouble getting them down. Maybe, you’re eating less. Your fatigue is prolonged.

2. Extra sleep doesn’t help. Getting many nights of extra sleep in a row or sleeping for an entire weekend doesn’t seem to diminish your fatigue. Perhaps worse, you feel as if you’ll never “catch up.”

3. Excessive sleepiness. You doze at inopportune moments, such as during an important meeting, or when driving!

4. Loss of sex drive. This isn’t obvious because decline in libido usually occurs a bit at a time and you don’t notice, although your partner likely will.

5. Interrupted sleep. At night, you wake more often or toss and turn, and then, worse, you spend the rest of the night overly concerned that you’re not attaining good sleep.

6. Persistent fatigue. You feel tired upon arising even after a full night’s sleep. Realistically, if, by 9:30 a.m. or 10:00 a.m., you can hardly keep your head up, it’s time to take heed.

7. Poor concentration. Your focus on the task at hand is poor. Your concentration is diminished and is not due to your aging.

8. Feeling ineffective. Finally, you feel that you’re no longer in control. In many ways, this can be the most worrisome of all signs. Roll back your number of working hours as soon as you reasonably can.

If one or more of these has been a lingering issue for you, it’s time to take a personal inventory and make some decisions about how you are going to change things


The Power of Big Data


Harnessing and capitalizing upon the monstrous amounts of available healthcare information

By Peter Edelstein, MD, Elsevier

Big Data. Population Health Management. Patient Engagement.

Healthcare reform churns out buzzwords at an alarming rate.  But at least big data has a more defined meaning, having come to linguistic life long before the Affordable Care Act was a gleam in President Obama’s eye presumably.

Today’s world runs on big data.”  It’s big data that allows millions of us to almost instantaneously receive insurance quotes online; creates your credit score; select a mortgage; and pushes pop-up advertising that just happens to be exactly what you were looking for yesterday.

As is our healthcare industry’s history, big data is yet another capability that has entered the medical arena long after becoming an integral part of non-medical sectors.  That said, big data is (finally) here to stay, in our hospitals, our pharmacies, in our insurance systems (where it has been the longest), and in our ambulatory care centers.

Big Data Goals

And like population health management, patient education, and other buzzwords, understanding our specific big data goals and how to achieve them is critical if we are to maximize the success of healthcare reform.  So the first question is, What Are Our Healthcare Goals for Big Data?

If an underlying goal of healthcare reform itself is to improve the quality and cost efficiency of care for populations and for individual patients, then we must turn away from reactive care provided in the acute, inpatient facility and strive for proactive, preventative, and maintenance care provided in the ambulatory world (both the outpatient physician office and in the place where patients spend virtually 100% of their time:  their homes and workplaces).

Linking to this goal, Big Data can drive the identification of individuals and populations at risk of suboptimal quality and/or cost of care and then to guide intervention to reduce or prevent the realization of the identified risks.

Already, Big Data is playing a foundational role in the first part of this goal.   Monstrous amounts of claims data serve to feed clinical analytics models, including predictive models.  Such powerful tools allow us to predict which patient populations and individuals are at risk of specific forms of clinical deterioration, high cost care, and/or unanticipated hospitalization and Emergency Department visits.

And recently, the incorporation of public records Big Data (including moving, home ownership, eviction, lien, and property value history; estimated annual income, wealth index and financial stress; and accident, fraud, burglary, and criminal history) along with health claims data has allowed for the development of even more powerful predictive analytics models.  (For example, inclusion of such non-medical data may more accurately predict risk of early post-discharge hospital readmission and/or risk of failure to pay).

Big Data Expansion

Today, non-clinical Big Data is expanding from the clinical analytics world into site of health care delivery.  The Institute of Medicine is recommending the inclusion of social and behavioral data within the EHR, where (as with analytics) this expansion of Big Data is projected to more clearly and accurately guide patient care.

Whether empowering clinical analytics models or more clearly defining individual patients and populations from within the EHR, the ultimate impact of our evolving Big Data is in guiding evidence-based content and clinical decision support tools which are targeted to meet the specific needs of an identified patient population, subpopulation, or individual, content which can be pushed to every point of care (hospital, ambulatory setting, patient home, etc.) and delivered in a format appropriate for the specific provider (doctor, nurse, patient, etc.).

As we widen the net of data sources and types included within our analytics models and electronic information systems, we are increasing our ability to hone down, to fine-tune our understanding of specific and populations’ and patients’ risks, needs, and opportunities to improve both the quality and cost efficiency of their care.  To provide the most appropriate evidence-based content wherever it needed, whenever it is needed, for whoever needs it.

Peter Edelstein is chief medical officer, Elsevier Clinical Solutions