31 July 2012

Midwest Edition
Calendar
August 9
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Accretive Settles Minnesota Charges

Pays $2.5 Million Over Pressuring Of Patients
Accretive Health, the Chicago-based debt collector for hospitals that had been accused by Minnesota Attorney General Lori Swanson of pressuring patients to pay for care before they received it, settled a lawsuit on Monday regarding its business practices. Accretive agreed to pay almost $2.5 million and discontinue operating in Minnesota within the next 90 days in lieu of Swansons ofce dismissing the lawsuit. It has the option of doing business in Minnesota two years after it winds down its operations, but only with the consent of the Attorney General. The settlement money will be used to compensate patients, with excess funds going to the states treasury. A hospital emergency room is a place of medical trauma and emotional suffering for patients and their families. It should be a solemn place, not a place for a nancial shakedown of patients," Swanson said in a statement. Although Accretive had repeatedly asserted it had engaged in legal practices, the settlement was announced just a couple of weeks after Swansons ofce released a lengthy report of more than 20 patients and family members who had been pressured by Accretive employees to pay up prior to receiving care. In one instance, a patient was pressured to produce her credit card as she was laying on a gurney after suffering a stroke. Even though we believe the claims against us were either baseless or exaggerated, we have used this opportunity to carefully examine our own practices in order to ensure we are setting the very highest standards for our own performance and achieving the best possible outcomes for hospitals, patients and communities. said Accretive Chief Executive Ofcer Mary Tolan in a statement. Entering into this settlement...allows our company to put this matter behind us and prevents further distraction from the important work that we do for our hospital clients. The company did not admit wrongdoing as part of the settlement. Tolan added that Accretives exit will cost Minnesota about 100 jobs. Swansons suit, led in January, stemmed from a fairly innocuous incident: A company laptop containing data from more than 23,000 patients from two Minnesota hospitals was stolen from an employees rental car in 2011. But after looking deeper into Accretives business practices, Swanson asserted the publicly-traded rm was taking part in overly aggressive collection tactics at the hospitals

September 6-8
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September 9-11

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Continued on Next Page

WEBINAR
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Wednesday, August 15, 2012

Noon, CDT

HEALTH BENEFIT EXCHANGES: A PROGRESS REPORT

Please join David Panush, director of government relations, the California Health Benefits Exchange, Anthony Wright, executive director, Health Access, and Jon Gabel, senior fellow, NORC/University of Chicago, to discuss the next major step in the implementation of the Affordable Care Act in California.

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NEWS
Accretive (Continued from Page One)
operated by Minneapolis-based Fairview Health Services. According to Swansons ofce, employees were placed at Fairview facilities posing as hospital employees and pressuring patients and their families to pay for care. Fairview employees were also pressured to use special software to track patient accounts and ensure they were asked for payments upfront, according to investigators. A followup report released by Swansons ofce earlier this month named patients and their specic circumstances when they were approached for collections. Aside from the stroke victim, a 63-yearold pastor was asked for $1,500 prior to

Page 2

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In Brief
Minnesota Blues Foundation Makes $510K In Grants
The Blue Cross Blue Shield of Minnesota Foundation has provided 22 grants totaling $510,000 to help fund social and health improvement initiatives across the state. The largest grant, $100,000, went to The Family Partnership Minneapolis to fund a project to improve relations between Native Americans and Somalis living in close proximity in Minneapolis. The grants were chosen by community judges from nearly 400 applicants. Relationships matter to your health. Strong connections between friends and neighbors help people to be more involved in their communities, perform better in school and live longer and happier lives, said Carolyn Link, the foundations executive director.

undergoing a hip replacement procedure, a total he had to negotiate down to $700 because he could afford not more than that. In another case, a mother was told her newborn son would not be allowed to leave the hospital until she paid her bill a tactic Swansons ofce referred to as baby prison. Accretive said it did not expect the settlement to have any adverse effect on its operations the rm has more than $200 million in cash on hand. Accretive stock had taken a beating as a result of Swansons allegations. However, it rose 20% in after-hours trading on the New York Stock Exchange on Monday. TAMMY WORTH

Uncompensated Care In Iowa Soars

Double-Digit Increase Between 2010 and 2011
The recession may be receding, but the countrys improved economics have not necessarily trickled down to hospitals. According to a report released recently by the Iowa Hospital Association, the states 118 community hospitals provided more than $950 million in uncompensated care in 2011, up $100 million, almost 12%, from the previous year. If there is a recovery happening, we will likely see more hints of it in the next report, said Scott McIntyre, spokesperson for the association. But the numbers here dont indicate much of a recovery if we are judging from the levels of charity care and bad debt. The hospitals also had losses of $274 million from Medicare and Medicaid underpayments up 17% from 2007. According to the report, more than 60% of the states hospital revenue comes from these two payers. Some of this pain will be alleviated as states increase payments to primary care providers in 2013 and 2014, as required by the Affordable Care Act. All states will be required to increase Medicaid payments to fall in line with what Medicare pays, which traditionally pay more generously. Those states that expand their coverage will have much of the higher matching rate paid for by the federal government beyond 2014, according to the Center on Budget and Policy Priorities.
Continued on Next Page

Gentiva Health Acquires Indiana Hospice

Gentiva Health Services, the Atlanta-based, publicly traded hospice services firm, has acquired Advocate Hospice in Danville, Ind. Gentiva is acquiring the hospice for cash. Terms were not disclosed. The addition of Advocate Hospice to the Gentiva family enables us to expand our coverage in central and southern Indiana and to leverage our existing hospice and home health capabilities in the

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Longer ALOS!*

NEWS
Iowa (Continued from Page One)
Iowa Gov. Terry Branstad, along with many of his Midwestern counterparts, have spoken out against the expansion in their states. A report released in April by the Missouri Foundation for Health found that bad debt expense increased from $137 million in 2004 to $256.5 million in 2008 at the hospitals surveyed in the study. Bad debt has outpaced the growth of charity care by 22% a year since 2004, according to the report. But the Midwest generally hasnt had the

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In Brief
state," said Gentiva CEO Tony Strange. "Going forward, we will continue to pursue acquisitions that make strategic sense and fill in geographic gaps in both of our divisions, while balancing these efforts with our continued focus on debt repayment.

deep cuts in the economy that other areas have seen. According to the MFH, prot margins for more than half of the hospitals in the study were higher than the national average. And unemployment is lower in Iowa and hospitals are doing OK, McIntyre said. Hospitals are expanding across the state and healthcare jobs are steady, he said. Hospitals are working with it well; they havent had layoffs and I havent heard much about hiring freezes of late, he said. TAMMY WORTH

Streamlining Michigans Safety Net

New Study Suggests ACA Could Cut Duplication
A new report by the Center for Healthcare Research and Transformation forecasts that as many as 500,000 Michiganders will be eligible for Medicaid should the state decide to expand its program as part of the Affordable Care Act. Moreover, the Ann Arbor-based CHRT contends that employing ACA in Michigan could be used to simplify a patchwork of dozens of programs that allow Michiganders to enroll in Medicaid. Altogether, there were about 1.7 million Michiganders enrolled in Medicaid in 2011, according to the Kaiser Family Foundation. That represents about 16% of the states overall population. According to the CHRT study, there are currently at least 40 different points of entry into the Michigan Medicaid program, all with varying eligibility requirements. As part of ACA, the existing categories in Michigan will be consolidated into three eligibility categories: Parents with dependent children under 19; pregnant women and children under the age of 19. Income eligibility will be up to 138% of the Federal Poverty Level. Many changes were included in the ACA that go beyond the Medicaid expansion. These changes were designed to make enrollment policies and processes simpler for those who have existing Medicaid coverage, and enable those newly eligible to go through an easier enrollment process than exists today. These enrollment changes alone should help ensure that more people have access to the affordable care when they need it, said CHRT Director Marianne Udow-Phillips. Whether Michigan will expand its Medicaid program remains to be seen. Although under ACA the federal government would pay for virtually all of the cost of expansion in the rst several years after Medicaid expansion takes place in 2014, Gov. Rick Snyder, a Republican, has yet to announce whether he intends to accept the money for expansion. Many GOP governors have said they would reject expansion.

Capital Healthcare Trust Acquires Wisconson Medical Office Buildings Run By Aurora Health Care
New York-based Realty Capital Healthcare Trust has acquired three medical office buildings in Wisconsin for $63 million. The buildings are located in Two Rivers, Neenah, and Hartford and had been owned by hospital system Aurora Health Care. They will continue to be leased out to Aurora. Altogether, Reality Capital now owns 34 properties with a total value of $409.7 million. We are very pleased to complete the acquisition of these three highquality, recently constructed medical office buildings leased and operated by one of the largest and most reputable healthcare systems in the state of Wisconsin, Aurora Health Care," said Tom D'Arcy, chief executive officer of American Realty Capital. As we effectively deploy our capital, these properties add to our diversified portfolio, focused on healthcare assets leased to strong national and regional operators on a long-term basis.

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OPINION

Page 4

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A New View Of Americas Physicians

Their Bedside Manner as Seen From Across The Pond
I am not a doctor and I dont play one on TV. I You have gout! am, however, an occasional patient. So while I To say that I was astonished would be an am not qualied to write about airway understatement. management or anesthesia carts or the pros Gout? How do you work that out? and cons of scrub laundering services, I am Well, you are English and the English ideally suited to ponticating about drink a lot of port wine and too much port physicians, their foibles and forts. wine often leads to gout. My rst encounter with an American I suddenly had an urge to take to the physician was a memorable one. I had been in bottle, possibly copious quantities of port the US only a few months after arriving from wine. But instead I sought a second opinion. England. With every yin, I was directed to an however, there is a yang. examination room where I Since then I have been waited patiently, and patientinnitely more fortunate in like, for the physician. my visits to physicians. I After a while, a long while, I have undergone knee heard footsteps in the corridor surgery, watching the outside, some activity, rustling specialist clean out of papers, and a loud voice fragments from my patella saying: Whats this guys on a monitor while being name? followed by the genuinely entertained by a nurses whispered response: fascinating and informative Geoffrey Charlton-Perrin. commentary from the The door ew open. In walked physician as he explained a physician I had never met in what he was doing and why. my entire life, arms And eventually I had surgery By outstretched, a beaming smile on his on my shoulder - yes, that shoulder Geoffrey to repair my rotator cuff at the hands face, as he bellowed, Geffy, baby! and hugged me like I was his long-lost Charlton- of a surgeon and surgeon assistant chum from childhood. who were not only artists at their Perrin Friendliness, accessibility, craft but friendly, helpful, informative unpretentiousness these are welcome and down-to-earth. qualities in a man of medicine. But there is And the reason I can say with some such a thing as too much friendliness, authority that they were artists? I was accessibility and unpretentiousness! producing a video on ambulatory surgery I remember another encounter some years center accreditation at the time and had the later when I was experiencing extreme entire procedure lmed so I could include discomfort in my right shoulder. Every time I parts of it in the video. raised my arm to pitch to one of my young Afterward in the editing room, I marveled sons, I felt a erce, stabbing pain that at the skill, the deftness, the sure hands of prevented me from completing the movement. both physicians. And thanked my lucky stars I went to a physician who enjoyed great that I wasnt witness at the time to what they renown as ofcial orthopedic surgeon to were doing to my body with what looked the citys hockey team. Hockey players must suspiciously like a hammer! For a patient, often have shoulder problems, right? How some things are best left a mystery. could I go wrong?, I reasoned. He examined me carefully, put me Geoffrey Charlton-Perrin is the director of through several tests, but failed to come up marketing and communications for the with an answer. More examinations. More Accreditation Association for Ambiulatory tests. Still no answer. At the third visit, as I sat Health Care. on the exam table being poked and prodded for a third time, he straightened up and delivered with some fanfare, I might add Op-ed submissions of up to 600 words are welcomed. Please e-mail proposals to his considered opinion.
editor@payersandproviders.com

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Page 6

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