Sonoma County patients criticize Providence’s aggressive collection of medical bills

Their job was to get as much money as quickly as possible from the people receiving medical care in the emergency department at Providence Santa Rosa Memorial Hospital.

Until about a year ago, patient registration staff at the North Bay’s largest hospital were regularly ranked according to who brought in the most cash from their patients, whether those patients had private insurance, were on Medi-Cal or had little money at all, according to an internal score card obtained by The Press Democrat.

Even now, the highest producers receive gift cards for their performance, according to a former Providence employee.

“I was the one asking for money every day. Every day,” said Taylor Davison, who until last year worked in Memorial’s emergency room. “We were ranked every month — based off the hours we worked — on how much money we collected in copays broken down by the hour.”

The emergency department’s patient registration staff receive an email from their supervisor each month detailing how much money in copays and cost-sharing each employee had secured from patients, Davison said. They were told to ask patients repeatedly for money, she said.

The practice was “ugly” and inappropriate for emergency room patients, she said.

“We were supposed to go in as soon as the doctor left the room,” she said. “We couldn't legally go in there and ask you anything until the doctor had seen the patient. So we would literally go as soon as the doctor left the room. We would come in, verify all their information, update everything on their account and then ask them for money.”

The new details on practices at Providence, one of the nation’s largest health care systems and Sonoma County’s dominant hospital operator, come in the wake of a critical New York Times report that detailed how the nonprofit system used aggressive tactics to induce payment even from low-income patients who qualified for free care under government health programs.

The Times report, published last week, found Providence paid millions of dollars to a consulting firm to come up with a strategy to maximize collections from patients. Some former Providence employees described the strategies as predatory and said they were used at inopportune moments during hospital visits.

Staff were expected to repeatedly ask for payment and collect whatever they could, the Times reported.

Davison, who was quoted in the article, told The Press Democrat the monthly employee rankings — which were not disclosed in the New York Times report — were particularly troubling for her. She said she quickly lost the stomach for collections work and quit last summer.

Providence, in response, said it has since revised, reviewed and improved many of its collections practices.

Melissa Tizon, a national company spokeswoman, said in an email that “any productivity worksheets that are in use today are not to incentivize practices inconsistent with our values.”

Tizon said the spreadsheet provided by Davison was three years old. But Davison said that when she left a year ago, the rankings were still being done.

Providence took over Memorial Hospital, Sonoma County’s primary trauma care facility, as well as Queen of the Valley Hospital in Napa, in a 2016 merger with St. Joseph Health. It also controls, through a subsidiary, the hospitals in Healdsburg and Petaluma after voters handed over public ownership of the financially struggling sites in two 2020 elections.

Tizon said Providence prioritizes serving those in need, regardless of their ability to pay. That philosophy is central to the system’s mission, she said, adding that staff are instructed to inform patients about the availability of financial assistance in a number of ways. Financial counselors are also available to assist patients with the process.

But several recent Providence patients shared stories with The Press Democrat that echo the New York Times findings.

$50? $5? 50¢?

The pain Bill Harmon experienced in his chest on Monday, Sept. 19 made him fear for his life. The 62-year-old Monte Rio resident had just spent most of June at Memorial Hospital recovering from double bypass open heart surgery.

Now, he thought he might be suffering a heart attack.

Harmon’s wife called 911 and shortly after 10 p.m., he was in an ambulance headed for Memorial’s emergency department.

Though he spent 14 hours waiting to be admitted, Harmon said the care he received from Memorial’s medical staff was top-notch, as was the earlier care he received from doctors, nurses and medical techs in the cardiac department during his surgery in June.

Harmon said he was lying in a small room in the back of the emergency department early Tuesday morning, Sept. 20, hooked up to monitors. He said he was waiting to be admitted for observation by a cardiologist, when a staffer came into his room seeking payment.

“He goes, ‘You have a copay due, would you be willing to pay it today?’ I go, ‘No, I don't have my wallet, I don't have a driver’s license, I don’t have nothing.’

“They took me from my house by ambulance and I'm wearing sweatpants and a T-shirt and slippers. He said to me — after I told him I had nothing with me, not my checkbook, no cash, nothing — he goes, ‘$50? $5? 50 cents?’”

Harmon said he became angry and, using an expletive, told the employee to get out. About an hour later, another employee came in and reminded him of his copay.

Tizon, who is vice president of communications at Providence, said she could not comment on Harmon’s experience at Memorial because of patient privacy laws. She said Providence strives to ensure its staff are always interacting with patients compassionately and respectfully, as well as at the appropriate time.

“The interaction you describe is not consistent with our practices or values,” she said.

Charity care or bottom-line burden?

The New York Times report raised questions about the falling level of charity care provided by Providence as a tax-exempt, nonprofit hospital. The company’s tax status helps it avoid more than $1 billion a year in taxes, the newspaper reported. In turn, the federal government requires tax-exempt hospitals to provide free care to the poor and other services that benefit local communities.

“But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions,” The Times wrote.

Providence, in a published statement this week, denied it was taking advantage of vulnerable patients. Its growing health care system, which stretches across the seven states and includes 52 hospitals, provided $1.9 billion in community benefit in 2021, the company said.

However, only $271 million of that was actual charity care, according to the Providence statement. The bulk accounted for care provided to Medicaid patients, recorded as a $1.2 billion loss. Typically, that stems from the gap between the cost of treatment according to a hospital or its providers and the amount Medicaid reimburses.

According to a recent annual report, Providence reported revenues of more than $27 billion for the fiscal year ending December 2021.

Tizon said that for patients who can afford it, Providence is “required to collect copays and out-of-pocket costs as part of our contractual agreements with the insurers and per applicable laws and regulations. Getting paid by the insurers and those who have the means is also essential to our ability to cover the cost of delivering care.”

But one recent local Providence patient said he was troubled by the timing of that request.

The patient, a Sebastopol resident who asked that his name not be used to protect his medical privacy, said he went to a Providence facility near the Santa Rosa hospital for an MRI about a month ago and was asked to pay his share of the cost before the procedure. He said he usually never prepays and waits until the bill is processed by his insurance company.

“When I checked in, they said ‘You need to pay for your procedure,’” he said. “I said, ‘No, I’m not going to prepay for the procedure.’”

The patient said he was told he would get a credit back from the insurance company. “I said, ‘No, that's not the way it works. You bill my insurance company and then I pay the deductible.’ And they said, ‘Well, we're not going to be able to do the procedure.’”

He said he relented and paid up front about $500 of the $1,200 MRI cost, though he ended up paying a little more because of his deductible. The experience did not sit well with him. He said people have private insurance because hospitals and medical providers have negotiated rates for service.

Still, patients can often be confounded by the billing process, he said, and even more so when handled in such a pushy manner.

“With a lot of insurance companies you need to have a medical degree to understand what's in network, what's out (of) network, what’s considered an elective procedure and when that's not. So, I depend on my insurance provider to tell me, yes, we're going to pay this and you'll need to pay that.”

Hounded for payment

Jenifer Conte-Hernandez, a single mom who lives in southwest Santa Rosa, said she’s being hounded by Providence to pay for treatment her son received at the hospital’s emergency department two months ago after he was struck by a car on Sebastopol Road.

Conte-Hernandez, 43, said her 18-year-old son has “no-cost Medi-Cal” — referring to California’s program for low-income individuals and families — and is not required to pay any cost-sharing for emergency treatment.

She estimated she has received a dozen calls and voice mails and half a dozen letters from Providence seeking payment. Now, she said, she is seeking legal counsel.

“Oh my gosh, they harass me like crazy,” she said. “I get like two, three calls from them, and then I get so many invoices.”

Conte-Hernandez said Providence is trying to get her to pay a little more than $700, which would be a hardship for her. “I'm a single mom and I'm on disability right now because I'm dealing with my own health issues,” she said.

Davison, the former employee, said that when she was working in the emergency department, she and other staff members were expected to meet a goal of about $30,000 a month in collections. Emails from her supervisor showing the staff collections rankings often pointed out her department’s shortcomings, she said.

One email, provided by Davison, reads: “Our collection goal for March 2019 was $28,050.00. As a team you collected $16,555.00, which is 59% of our goal.”

But sometimes they met their goal, and the response from Providence supervisors was jubilant.

“We soared to success this past month!!” read another email Davison shared. “Our collection goal for April 2019 was $28,050.00. As a team you collected $31,392.00, which not only met our goal but exceeded it by $3,342! Thank you all, for doing a fabulous job! I knew you could do it!”

Tizon, the Providence executive, said that in some cases the option to prepay benefits the patient.

“For patients who have the means to pay, we offer a 10% discount if their out-of-pocket costs are paid within five days,” she said. “Many of our patients see this discount as a benefit that they appreciate.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.