The University established a Billing and Collection Practices Advisory Council Oct. 28 in response to a Washington Post article published Sept. 9, which exposed the University Health System for the extreme billing, money collection practices and lawsuits that were pushing lower- and middle-class patients over the financial edge. The advisory council’s next meeting is scheduled for late November.
According to the article, patients were sued more than 36,000 times for over $106 million over the course of six years until June 2018. The bank accounts and wages of patients were seized, properties and homes were liened and families were forced into bankruptcy.
The Council held its first meeting Oct. 30, and it is made up of 16 individuals from different sectors within the University and Charlottesville community, in hopes that the University Health System will hear the stories and gain insight from all perspectives. Elizabeth Beasley, director of community partnerships for the University Health System, is serving as the Council’s staffing member. With the role to build mutually beneficial relationships between the Health System and community partners, Beasley was asked by the Health System leadership to identify key stakeholders that the hospital would want to hear from.
“Council members were selected to provide a range of community voices, including community members with leadership roles,” Beasely said. “Some were nominated by other leaders and stakeholders and some were asked to join based on my working relationship with the individuals.”
Karen Waters-Wicks, community education coordinator at Albemarle High School, will act as the facilitator for the advisory board. As someone who was married to a graduate student and then became a single mom and who has worked very closely with Charlottesville’s low-wealth community in Charlottesville, Waters-Wicks brings a unique perspective to the table.
“This group has been convened to gather information and provide feedback and guidance to the University … on whether the changes they’re going to put into place are workable,” Waters-Wicks said. “We're trying to learn more about what has happened, what's being proposed going forward and make sure that it is going to do the least harm as possible to the community.”
In addition to Waters-Wick’s perspective, the Council includes a wide range of individuals, from a clergy member and Latinx community translator to a health care reform worker and West Haven Clinic nurse. The Council will also be in communication with the chief financial officer of U.Va. Health, Douglas Lischke, who ensures the hospital runs in the most cost-effective manner and manages records. Fifth-year Nursing student Tyler Gaedecke will serve as the undergraduate representative on the Council.
“This is a group of people who want to know what the community thinks,” Gaedecke said. “Whether or not people feel heard by the Health System, they can definitely feel heard by us … We're there to represent people as they want to be represented.”
According to Gaedecke, the pressure from America’s overall healthcare system to make a high profit has made it appear impossible for hospitals to change their practices.
“We need to challenge healthcare systems and providers to see themselves as agents of change with a lot of collective bargaining power,” Gaedecke said. “Change has to start somewhere with organizations finding new and more creative ways to support their patients and communities instead of operating solely within the same systems of power and profit as their peers.”
Through his clinical hours in the West Haven clinic, Gaedecke has heard many first-hand accounts on the effects extreme health care costs have on families in the area. It is through these stories that Gaedecke hopes to make changes.
“More than anything, I just think that healthcare needs to start being more of a community effort,” Gaedecke said. “I think that it's such a business these days, that it's no longer about the people it serves. What we need to do is use stories and situations like this to fuel our desire to change what the bottom line is.”
According to Waters-Wicks, the cost of service and confusing billing practices contributed largely to hospital collection concerns, leading patients to pay more than necessary. In the past, patients could get multiple bills from multiple entities, making it easy to mistake important bills for junk mail, causing patients to end up in collections and then court.
Since the hospital’s billing and collections actions have been brought to the table, changes have been implemented to alleviate some of the financial burden, and lawsuits have seen a drastic decrease, Waters-Wicks said. Lawsuits on anyone earning less than 400 percent of the federal poverty guideline will be terminated. For example, a family of four making $103,000 falls into that category. Before, patients were sued for money amounts ranging from $13.91 to $1 million, according to The Washington Post article. Now, U.Va. Health will not see legal action on patients owing less than $1,000 regardless of their income. The hospital will try to get a payment plan for these patients but won't seek a judgment in court. This will be applied to any open balances that date back to July 1, 2017.
With the establishment of this Council, the goals go further than simply fixing the University’s issue. Both Gaedecke and Waters-Wicks see this issue as not only local but also national, as this new system could serve as a model for other institutions around the country.
“I think U.Va. has the opportunity to be a leader in this,” Gaedecke said. “It feels like we can solve our problem in a way that we can also support communities like ours, everywhere … and I hope that we can be brave enough to do that.”
“Just in our current environment, healthcare is a major issue,” Waters-Wicks said. “When you look at out of pocket costs, you’re one injury or one illness away from financial ruin. U.Va. is one of the top institutions in the country ... if we can't figure this out, there’s a problem. If anybody can figure it out, U.Va. should be able to, and I'm glad that the community is going to hold them accountable for it.”