Small hospitals cope with rural health crisis (copy)

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Cassie Symons, a physical therapist assistant, works with patient Peter Langreck, who had a bilateral knee replacement, at Marshfield Medical Center-Neillsville. Wisconsin hospital lawsuits against patients over unpaid bills are rising, with the highest rates among small, rural hospitals, a new study said.

Lawsuits by Wisconsin hospitals against patients over unpaid bills rose 37% from 2001 to 2018, with small, rural hospitals suing the highest proportion of patients, a new study found.

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The share of cases resulting in patients having their wages garnished to pay back medical debt increased, according to the study by researchers at Yale and Stanford universities, published Monday in the journal Health Affairs. Black patients were sued more than whites, the analysis suggested.

“We have a health system that is putting immense financial pressure on patients,” Zack Cooper, an associate professor of health policy at Yale and co-author of the study, said in a statement. “Whether it’s surprise medical bills or this rise in hospitals suing over unpaid medical bills, these kinds of financial risks make patients wary of going to the hospital for care they need.”

Tim Size, executive director of the Rural Wisconsin Health Cooperative in Sauk City, which represents many of the state’s rural hospitals, said the study comes as the hospitals are struggling with staff shortages and influxes of COVID-19 patients.

“I believe access to health care should be a right, but those of us in rural health have to play the cards we are dealt, and needing to collect from patients who don’t work with the hospital to do ‘what they can’ to settle part of the bill is part of that landscape,” Size said in an email.

Friendship hospital

Gundersen Moundview Hospital in Friendship.

Gundersen Moundview Hospital in Friendship filed 434 small claims, civil claims or hospital lien cases in from 2014 to 2018, or 46.7 per 100 patient discharges, the highest rate during that period, the study said. Mile Bluff Medical Center in Mauston filed 1,763 of the lawsuits during that time, or 27.4 per 100 patient discharges, the second-highest rate.

“Sometimes health care providers across our state and nationwide will send accounts to collections after all efforts to provide financial assistance have been exhausted,” Gundersen spokesperson Chris Stauffer said in a statement, responding to a question about lawsuits at Moundview, which became part of Gundersen in late 2017.

“Patients have many options, including interest-free payment plans, discounts for uninsured and free estimates for out-of-pocket expenses,” Stauffer said. “Still, more work needs to be done locally and across our industry to reduce the cost of health care.”

Mile Bluff CEO Dara Bartels said the hospital has restructured its billing team to more quickly identify problems patients have with payments.

“We have added financial counselors to our team to provide education on, and connect patients with, resources available for assisting with medical payments,” Bartels said.

Size said small, rural hospitals tend to have lower operating margins and less money to subsidize patients than larger hospitals. Most of the state’s rural counties have been struggling financially since the Great Recession in 2007-09 and were just recovering when the COVID-19 pandemic hit, he said.

“I believe the answer doesn’t lie in criticizing those that are struggling so hard to bring care to rural communities,” he said.

St. Agnes Hospital in Fond du Lac, now part of SSM Health, filed 2,632 lawsuits in 2014-18, the most in the state. Mile Bluff had the second-highest total and Waukesha Memorial Hospital was third, with 1,687 lawsuits.

In 2014-18, UW Hospital filed 492 lawsuits, UnityPoint Health-Meriter filed 102 and SSM Health St. Mary’s Hospital in Madison filed 14, the study said. The cases accounted for 0.3 or less per 100 patient discharges at the Madison hospitals.

Other hospitals with the highest lawsuit rates were Reedsburg Medical Center, with 22.3 cases per 100 discharges; Our Lady of Victory Hospital in Stanley, now part of Aspirus, with 17.2 cases per 100 discharges; and Divine Savior Hospital in Portage, also now part of Aspirus, with 16.2 cases per 100 discharges.

Overall, the hospital lawsuits increased from 1.12 per 1,000 Wisconsin residents in 2001 to 1.53 per 1,000 residents in 2018, the study said. The average lawsuit amount was $3,391, and cases resulting in wage garnishments rose from 41% in 2011 to 52% in 2018.

Based on census block data and a method of inferring race from surnames, there were 1.86 lawsuits per 1,000 Black residents in 2018 compared to 1.32 per 1,000 white residents.

The researchers focused on Wisconsin in part because the state’s lawsuit information is accessible and it is one of 12 states that haven’t expanded Medicaid as allowed under the Affordable Care Act, Cooper said. That enabled an analysis not impacted by significant changes in Medicaid coverage over the years studied, he said.

Fave 5: Reporter David Wahlberg picks his top stories of 2020

My year as the State Journal’s health reporter has been consumed by COVID-19. I’ve covered many coronavirus developments and media briefings, but the stories that stand out most to me are those showing the humanity of the pandemic.

Four of my five picks are about people fighting COVID-19 or those who succumbed to it. The fifth, from that hard-to-recall time of January, looks at new genetic testing and treatment for spinal muscular atrophy, a rare muscle-wasting disease.

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