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StumbleUMC’s bill collections baffle
Commissioner wants to know why hospital in red sees so little of what it’s owed
Photo: Steve Marcus / Las Vegas Sun; Las Vegas Sun Photo Illustration
Wednesday, July 1, 2009 | 2 a.m.
Steve Sisolak
Sun Archives
- Grant to restore cancer programs at UMC (5-28-2009)
- Editorial: Possible relief for UMC (4-14-2009)
- Fighting for its life, UMC program loses patient (4-14-2009)
- Bill to open UMC cancer OK'd on party lines (4-9-2009)
- A black eye in medicine brings posturing, again (4-9-2009)
- UMC CEO: Bill to open cancer center doesn't address funding (4-8-2009)
- State measure could force closure of UMC, county says (3-31-2009)
- UMC might benefit from a hospital taxing district (1-18-2009)
University Medical Center is collecting less than 1 percent of its past-due bills, a situation that one county commissioner said needs to be quickly addressed to turn around the financially troubled public hospital.
Of the $459 million in past-due debt UMC was owed between October and May, its three collection agencies recovered just $2.9 million, or 0.6 percent, from former patients.
Commissioner Steve Sisolak, who began asking questions about the hospital’s debt collection practices because of its ongoing financial problems, said raising that rate by a few percentage points would bring in millions to avoid the embarrassing cuts in services the hospital has endured in recent months.
“It just seems unbelievable to me,” Sisolak said. “Why is it so low? It doesn’t make sense.”
UMC couldn’t provide details this week on how much of the debt resulted from treating uninsured and indigent patients, which is part of its mission as a publicly funded hospital.
But the International Association of Credit and Collections said its members reported in 2006 an average collection rate of 15.2 percent on unpaid hospital bills. John Nemo, the association’s spokesman, said the figure includes both private and not-for-profit hospitals like UMC, which typically treat a higher percentage of uninsured and indigent patients.
Increasing UMC’s collection to that industry average would bring in about $46 million, after agency fees.
In an e-mail to the Sun, UMC spokesman Rick Plummer said the hospital bills patients four times. If patients don’t pay, UMC then offers a discount to uninsured individuals who are Clark County residents and tries to work out payment plans, he said. If those efforts fail, the debt is turned over to a collection agency, according to Plummer.
UMC was unable to answer additional questions about the uncollected debt, including how long the $459 million had accrued.
Among the issues Sisolak wants to investigate further is whether the hospital staff is held accountable for inaccurate or incomplete paperwork that results in unpaid bills, what legal recourse, such as liens, is used to recover the money and if it’s made clear to patients that they are expected to pay for services.
“I’m not advocating going after senior citizens or those who clearly can’t afford to pay,” he said. “But does everyone out there figure they don’t have to pay when they come to UMC?”
UMC’s financial troubles led to the closure late last year of its outpatient oncology unit, in part to offset a 5 percent cut in state Medicaid reimbursements. The TV news magazine program “60 Minutes” reported on the closure in April, bringing an intense focus on the hospital’s budget deficit and prompting an effort in the Legislature to force the county to reopen the program.
The Lincy Foundation recently donated $3 million, which will allow the outpatient cancer unit to reopen.
At least one person who used to collect UMC’s past due debts said the hospital should be recovering more money from its former patients. Duane Christy, owner of Aargon Collection Agency, said his business was collecting about 23 percent of the hospital’s debt when it first began contracting with UMC in 1999. The rate dropped to about 10 percent in 2003, but the work involved bills that had been picked over by another collection agency, what’s known in the industry as “secondary debt.”
“I’m not here to bash UMC,” said Christy, who ran unsuccessfully last year for the County Commission seat held by Sisolak. “I’m just tired of seeing the county hospital lose money it doesn’t have to lose. I want to see that hospital survive.”
Christy said one of his clients is a private hospital in Las Vegas for which he recovers 9 percent of its secondary debt.
Without knowing the status of University Medical Center’s $459 million in unpaid bills, Christy said if it is “prime paper” — bills that haven’t yet gone to a collection agency — the agencies should be able to collect 15 percent.
Sisolak said he wants to see if it’s possible for UMC to come close to that figure.
“I just want some answers,” he said. “Because ultimately the taxpayer is getting hit again here and we need to come up with ways to stop that.”
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When I get sick, I'm going to UMC. I'll pay 1% of the bill, no problem. What a joke. "Nurse, where is my vicodin, I'm in a lot of pain?" Oh, I'm sorry, you speak only Filipino and broken English. Is this what we've come down to? Sad...
Now that's funny.
This is one of the primary reasons healthcare is so expensive. DEADBEATS! Believe me people can gamble their last cent,but virtually ignore their medical bills allowing you and I to pick up their tab. Hospitals need to go after the assets of these people. This is why health insurance not unlike auto insurance should be mandated for everyone and paid for with a national sales tax or vat tax. Then the drug addicts,dealers,prostitutes and other human flotsam will finally pay for their medical care. It can on longer be passed on to those who struggle everyday to pay their bills.
First....the CEO and CFO need to be "fired" The other administrators need to be put on notice and the board as well. You mean to tell me with several collection agencies in place they can't do better than that.Where are the board members in all this? Someone is getting paid off BIG TIME. The lack of funds translates into poor care,lack of equipment,canceled programs.This situation goes all the way down the food chain,it affects everything associated to the running of this hospital. How long...how many years did they allow this to continue? Their doors will be closing very soon,get ready ! They will never see another dime of this money...never
skbarrow:
I hope you never need emergency medical care or ANY kind because when that $5000 bill comes due and owing after your insurance pays the other $15000, I hope you have enough money AND a job to pay for that blll. My guess is a lot of people are having a hard time keeping a roof over their head because they lost their jobs, let alone afford to pay any hospital bill, along with their doctor's bills, prescription drugs, costs for tests that their doctors INSIST they get regardless if they can afford it or not. It is a catch-22. Let's not even mention if children are involved and end up in the ER or get sick.
Not everyone that goes to UMC are drug addicts, dealers, prostitutes or "other human flotsam". They are hard working people who need medical care. Even those WITH insurance cannot afford some of the outrageous costs hospitals charge ($5 for a Tylenol). I suppose you would rather see them all die instead of, God forbid, trying to take care of their families first, and their hospital bills second.
I hope you are not the next one that is on a gurney in the ER and as you are laying there in dire need of emergency care, they ask you if you can afford to pay your bill or insist right up front that you write out a check for $10,000 so they can proceed to save your life.
International law states that visitors are to be stabilized only. Return all non US citizens to their country of origin after stabilization if they are unable to pay the costs of their treatment. Require all visitors to this country to have and maintaine travel health insurance. All illegal immigrates need to be immediately deported. This will cure a lot of UMC's debt problem
Silly Steve Sisolak thinks that he is going to change things. Every time UMC's collections turn sour, certain know-it-all commissioners demand that UMC do better with its collections. When UMC or its collection agencies get more aggressive, constituents (voters) start calling their commissioners, and then UMC gets instructed to stop being aggressive with its collections.
Mr. Sisolak, UMC will improve with its collections when the County Commissioners find their collective spine.
I see the "know nothings" and want-to-be KKK members are out in force on this topic.
If only non-English speakers were the cause of our problems, we could round them up, lock them in prison, and force them to learn English by watching endless episodes of M.A.S.H. and Growing Pains.
But for those of us that simply want UMC to be solvent (and provide outpatient cancer care), why don't we help UMC aggressively go after non-paying patients. Even though enforcement may cost more initially, it is obvious that there are monies to be captured here - Debt Collector boasts more than 50% recovery rate, I say we give him/her a chance to prove it - and hopefully prove to everyone else that maybe you should be less concerned with blowing money in the casinos, and more concerned about paying your bills.
We need more free money from the government(they get it from where?) and just provide everything for free. That's Obama's plan and what will it fix? nothing.
Here is an idea:
Why don't we get the Las Vegas Fire Department Paramedics to chase down the deadbeats? We can give them $50 per deadbeat. That is more than they get for accurately writing down the patients info.
How could this go wrong? (rolling eyes in disbelief)
Commissioner Sisolak this problem really isn't that baffling. Especially when you look at the population that uses UMC. It's hard to collect on people who use county hospitals and ER's as their primary health care because they are either illegal, homeless or don't have insurance. So I think it's reasonable to conclude that your mystery is solved. When I was doing my internship at UMC I observed a couple of areas where UMC is being completely taken advantage of and I'll bet that most of the public is completely uninformed of. First, while I spent time in the maternity ward observing the patrons in the waiting room I noticed that when pregnant women were registering for service NOT ONE of them had a valid state ID. Nope I consistently witnessed Sam's Club, Costco, OH and the most common were those IDs from Mexico. So as I inquired about my observation to the nurse she said that UMC doesn't require state ID's, passports, green cards they have to take what is given to them (which to me is ABSURD). Then she proceeds to tell me that the worst part was that some of the family members may have a Medicare card and they pass that card around amongst the family members. Meaning that others in that family use that card to get free services also. Another abuse I observed was a man by the name of Pedro who came in to the ER to get his 3 times weekly dialysis treatment (uninsured & ILLEGAL) w/o a care (again the nurses couldn't deny him service). Now this is only a couple of examples @ 1 county hospital times that abuse by all the hospitals in the nation and MR & MRS TAXPAYER that is your generous contribution to our bankrupted non-bill collecting UMC. If you don't believe it - inquire for yourself any nurse or ER doctor will tell you the same. It's not really that hard to figure out Commissioner Sisolak why UMC's collection rate is so low.
How much of that past-due amount is from October-December and how much is from January-May? Granted, the collection rate is low, but if UMC was unusually busy in April and May, you would not see collections until July and August. As far as the issue of denying service goes, you have to treat and stabilize an emergency before you look for financial resources. Non emergencies can be turned away if the patient has an outstanding balance. Your doctor or dentist collects what you owe before you leave the office and they make sure you have insurance before they see you to begin with. Unless some of these outpatient services at UMC specifically exist to provide service for uninsured or underinsured people, there is no reason they can't practice in the same way as a doctor's office.
"I hope you never need emergency medical care or ANY kind because when that $5000 bill comes due and owing after your insurance pays the other $15000"
I don't know about you guys, but the max-out-of-pocket on my BCBS insurance is $2000 a year, and you can set that lower if you want to pay a slightly higher premium.
Anyone who gets blindsided by a huge charge is either going out of their network or has crappy insurance.
Healthcare reform needs to happen NOW!
If every citizen of the United States was fully insured, there wouldn't be all this debt. Taxpayers are getting the short end of the stick by having to pay higher taxes as a result of those that are uninsured and indigent. If there was a national program, the costs would be be beared accross the country and thus our taxes would be actually lower in the long run.
A single payer healthcare system is the only way to go.
goingbust:
A lot of the insurance companies not from an employer do have those high deductibles. A family member of mine had to get that supplemental insurance besides Medicare and was appalled at the cost of THOSE insurance companies. THe premiums were totally unaffordable AND had those high deductibles.
UNLVStud:
We the taxpayers will ALWAYS get the short end of the stick as far as the uninsured and indigent go. And....it will only get worse if a national health insurance system is put into place like the Obama Administration wants to do. I just saw a poll this week asking would you pay higher taxes so everyone in the country can be insured. At the time I checked, 87% said NO WAY!! What needs to be done if the gov't wants to get involved is crackdown on the insurance companies. We all know they overcharge. And while they are at it - go after the drug companies, too.
"Debt Collector boasts more than 50% recovery rate, I say we give him/her a chance to prove it"
Someone told me that once a doctor or hospital bill goes to the Bill Colllector - the doctor or hospital only gets a certain percentage of the original debt; the rest goes to the bill collector. And....once a bill goes into collections, the collection agency tacks on their own fee which is equal to a "juice loan"; in fact, "juice loans" are less than the fees a collection agency charges. So maybe that's why UMC can only come up with those figures since the bill collectors have all the rest!!!!
Why not hire Sallie Mae to collect all of that unpaid money. They are very good at harassing people with several phone calls every day. Even Tony Soprano would be impressed by Sallie Mae's collection tactics.
My earlier post of collection 56% recovery was removed? Why? Was it because I left my phone #? Sorry about that. Anyhow, we'd be happy to recover UMC's outstanding receivables. We've recovered profits for many businesses nationwide for pennies on the dollar.
I would like to comment on Balad's assessment, because being a former umc employee and also watching free medications given to people, and these are costly meds, I know for a fact that if pharmacy does not bill out the charges within 72 hours they are lost charges. We also did not bill on any amounts less then 5000, why because it was to costly to collect. But that is our administration and their supervisors and their supervisors. All departments are so over staffed. Attitudes over there is terrible. Just glad I am not there any more. Its run like a nazi war camp.
Give them to a collection agent in Mexico, they'll get the money out them. You could have the money or they would face less than pleasant results. I thought Vegas had good telemarketers and collectors?
Hard to get blood from a turnup, I mean a taco.
Obama's single payor system is not the answer folks. By its own admission, it will only insure 17 million people, still leaving 30 million Americans uninsured. In the meantime, it will balloon the federal deficit unless there are massive tax increases. If this financial crises taught us anything, it should have been that you cannot continue deficit spending without facing a day of reckoning.
Obama's supposed way of containing costs is simply to pay less. Nationwide, hospitals are operating on a 3-5% profit margin. Paying hospitals less, which is already being done in Nevada, will yield predictable results: the hospitals will run deficits. Eventually, private hospitals will be forced into bankruptcy or bailouts. And you thought the present system was a mess. Welcome to Obamacare!
ignorance abounds in Las Vegas. 70% of people filing for bankruptcy are doing so because of medical bills. 65% of them HAVE health insurance, look it up.
Calif. just started issuing IOU's. Calif is broke. We can't keep on running these deficits because we are passing the bill on to our children. Oops-- the bill just came due. Check out this article on colossal public employee pensions: http://online.wsj.com/article/SB12458009....
in response to Sureshot's comment...actually, not all collection agencies charge a percentage for recovery. Most agencies will charge anywhere from 30-50% and only collect about 20% of the time. Our agency only charges a flat fee of $10 per account. So, if UMC has a debtor that owes them $500 we'll collect it for $10, which equates to $0.02 on the dollar. A $1,000 collection would yield a $0.01 recovery cost. Please give me us a try. We'll get you paid, not us.
Wow, Sureshot! You might want to stay off the meth! Some people commented that a single payer system would solve the problem. I opined that Obama's proposals will not solve UMC's problem. In your impaired mind, you twisted that to say that I implied that Obama caused UMC's problem, when in reality, I only said that it is not the answer to UMC's collection issue. I'm sure that you're totally confused by now, so I look forward to yet another inane rant.
Perhaps Southern Nevada leadership will again blame it on ACS in Dallas for unacceptable collection rate failures. Find a goat.
Remember, leadership was inflammatory about suing ACS over collection outcomes under a contract two years ago, until ACS fired back fast. It kind of went away in the media after that, didn't it? Somebody backed down. ACS is a bondafide good company.
As for Lacey Thomas, he was publicly tarred and fired for collection failures (it's always about short term money, not the long term objectives) after a rather short stay at UMC also. But he would not have been offered the job at UMC had he not done a good job in the Chicago area prior.
Gee, Thomas is gone, why are there still unacceptable collection outcomes at UMC?
Mr. Sisolak, you are right to be probing for answers. Such questioning demonstrates you care about your new duties.
Mr. Sisolak, the answer is, at least, four fold.
First, low cost reimbursement structure in Southern Nevada.
Second, two few of the same hands in the fire for years in influence-control of Nevada healthcare.
Third, many in your local demographic, which is gaming and construction jobs, do not have the money to pay for healthcare, which the gaming lobby in Washington might want to expound on.
UMC has a high number of patients walk in for care, with no economic conscience about paying for it (because they don't have the means, and retail billing is atrociously high mark up), and they have no alternatives (see story on surgical procedures in back of store yesterday, not a good alternative).
Southern Nevada simply has an unacceptable number of residents who either want to (philosophically), or have to (necessity), live on the cheap, as in low taxes, credit card defaults (see national stats on Nevada).
But there sure are a lot of car insurance claims for theft and damage filed in Southern Nevada, as expressed in very high car insurance rates.
Fourth, Nevada leadership and the corporate gaming industry are are biding their time waiting for federal solutions and federal funding for healthcare, because Southern Nevada cannot afford the right solutions on healthcare for it's demographic without big, wide help.
Top quality providers and specialists do not want to come to Nevada for (a) low cost reimbursment structure, (b) no teaching hospital of merit, and (c) all the crap stories such as Endoscopy Center of Nevada, and the subsequent actions taken by the industry, that gives Nevada healthcare a bad name nationally.
The gaming industry simply does not have the money, year-in-year-out, to pay for a reasonable tax base to cover all the needs in healthcare and education, without help from somewhere else.
The help for UMC, and the entire State of Nevada, is going to have to come from a national healthcare plan from Washington.
It's that simple for Southern Nevada healthcare problems.