Maintain values while collecting medical debt

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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Minnesota Attorney General Keith Ellison is commendably investigating a controversial health care practice — cutting off nonemergency outpatient care for patients behind on their bills — after a New York Times story spotlighted Allina Health's use of this debt collection strategy earlier this summer.

In June, the Star Tribune Editorial Board called for Ellison's office to scrutinize Allina's policy and answer a key question: How many other Minnesota health care systems do the same? Yes, patients need to pay their bills. At the same time, the state's reliance on nonprofit medical centers raises expectations about having robust assistance programs in place for those who need help, particularly those struggling with a serious illness.

Ellison's move, announced Friday, is timely, and the inclusion of other Minnesota health care systems is appropriate. Mayo Clinic and HealthPartners told an editorial writer in June that they have similar policies that put scheduling holds on some patients. They're likely not the only ones.

The Editorial Board notes with approval that Ellison's office will hold one of two public "listening sessions" on this issue in Rochester, the southeast Minnesota city that's home to the state's world-renowned medical center. That's logical, particularly after a disturbing story by the Rochester Post Bulletin in late 2022 alleged that the Mayo Clinic had sued patients who could have qualified for charity care over unpaid bills. Ellison's office launched an investigation of Mayo in the story's aftermath.

The Rochester listening session, to be held Sept. 12 from 5:30 to 7 p.m. at Rochester Community and Technical College, should shed further light on Mayo's practices, which is needed. The AG's first listening session was slated for Wednesday night in St. Paul.

But Ellison shouldn't bear sole responsibility for ensuring collection practices are both fair and compassionate. Those who serve on hospital systems' governance boards have that duty as well.

The state's pioneering "Hospital Agreement" protects Minnesotans from unfair billing and collection practices. It also mandates that state hospitals provide reasonable payment options. Provisions in it clearly spell out boards' responsibilities, which include oversight of debt collection policies and a review of them "at least one time per year."

Because of these obligations, there should be ongoing reviews across the 128 nonprofits covered by Hospital Agreement to determine if patients have had any care suspended after falling behind on bills. If so, why did these individuals fall through the cracks of the institution's charity care programs?

On Wednesday, Allina admirably announced that it will permanently end its "termination of care" practice that generated the unflattering New York Times story. It had previously suspended the policy in June. "We have determined there are opportunities to engage our clinical teams and technology differently to provide financial assistance resources for patients who need this support," the Twin Cities-based system said in a statement. "We will formally transition away from our policy that interrupted the scheduling of non-emergency, outpatient clinic care."

That is a compassionate fix, one that aligns with Minnesotans' expectations for nonprofit medical systems that enjoy substantial tax breaks in return for providing a community benefit. Mayo's Board of Trustees and other medical governance bodies should follow Allina's lead and take action if necessary to ensure these policies reflect a nonprofit's mission and values.

Those with medical billing concerns can learn more or share their experiences at the attorney general's Minnesota State Fair booth. Consumers can also reach the attorney general's office by phone at (651) 296-3353 or (800) 657-3787 or by going online and completing the Medical Billing and Health Care Access Community Input Form.