Prominent doctors at UVA Health System are expressing public outrage at their employer’s practices to collect unpaid medical debt from its patients.
A Kaiser Health News report in September that showed UVA sued 36,000 patients over six years for more than $100 million, seizing wages and savings and even pushing families into bankruptcy.
Like many physicians who work at U.S. medical centers, the UVA doctors said they had little idea how aggressively the hospital where they practice was billing and pursuing their patients for payment.
Although the health system has announced some interim measures to scale back collections practices, some of the system鈥檚 most senior physicians are now calling for UVA to stop suing its patients altogether. And they are urging the pursuit of an “immediate solution鈥 to address the national epidemic of health care debt.
鈥淲e were appalled by the revelations of the aggressive, pitiless billing and collections practices鈥 at UVA, Dr. Scott Heysell and two other senior staff members wrote in a letter to KHN published Saturday. 鈥淲e felt betrayed,鈥 they wrote, 鈥渁nd we had, by extension, betrayed those who had relied on us.鈥
Heysell, an infectious-disease specialist and associate professor at UVA School of Medicine, and his co-authors echoed other UVA researchers and clinicians contacted by a reporter who said they were surprised and dismayed by the health system鈥檚 practices.
UVA initially defended its practices, pointing to the , which requires state agencies to 鈥渁ggressively collect鈥 money owed. But within days of the KHN report, UVA said it would reduce its use of the courts and make it easier for patients to qualify for financial assistance.
That鈥檚 not enough, said the letter鈥檚 authors, who include Dr. Rebecca Dillingham, director of UVA鈥檚 Center for Global Health, and Dr. Michael Williams, director of the UVA Center for Health Policy.
They ask 鈥渨hy UVA cannot join other public hospitals that have effectively stopped suing patients altogether?鈥
Other University of Virginia faculty said the system鈥檚 practices undermined their efforts to improve care for middle- and lower-income families and was not in keeping with an ethos of putting patients first.
KHN鈥檚 findings 鈥渕ade me feel utterly hypocritical about my work and efforts to promote health equity,鈥 Rajesh Balkrishnan, a UVA public health professor who researches cancer treatment in Appalachia, said in an interview.
鈥淭his is a public university with one of the richest endowments in the country,鈥 he said. “At least take care of the immediate community you serve.鈥
In September, UVA Health suing patients only if their household income is more than 400% of the federal poverty level, or $103,000 for a family of four. It also pledged to increase discounts for the uninsured and upgrade its financial assistance for patients.
Those measures are 鈥渁 first step,鈥 it said. On Oct. 28, it of community leaders, patient advocates and UVA students and staff to consider further changes.
鈥淲e are continuing to thoughtfully review our billing and collection practices to find additional ways to better serve our patient as well as improve fairness and transparency,鈥 said UVA Health spokesman Eric Swensen. 鈥淲e are looking at all options to achieve these goals.鈥
Virginia Gov. Ralph Northam, who oversees the state鈥檚 university system and public hospitals, is a pediatric neurologist.
鈥淎s a doctor himself, Gov. Northam agrees with the doctors who have taken a stand against unfair and aggressive medical billing practices,鈥 his spokeswoman said. 鈥淢uch more can and should be done to address this issue.鈥
KHN鈥檚 report prompted discussions across the campus in Charlottesville about how to treat uninsured patients or those with coverage who still struggle with thousands of dollars in out-of-pocket expenses, doctors and faculty said.
鈥淣o physician wants to be responsible for bankrupting a patient 鈥 not one physician, not one patient,鈥 said Dr. Mohan Nadkarni, UVA鈥檚 chief of general internal medicine. He is the only physician on the advisory council.
鈥淯VA physicians were completely taken aback by the scale and magnitude of the collections practices,” Nadkarni said. Discussion at the council鈥檚 first meeting reflected 鈥渓ots of pent-up dissatisfaction from community leaders鈥 about UVA鈥檚 practices, he said.
But many knew the health system was suing patients, they said. Some had firsthand experience with aggressive tactics from the billing office.
At one 鈥渢own meeting鈥 of health system employees, held at UVA鈥檚 Leonard Sandridge Auditorium in response to KHN鈥檚 report, somebody took the mic and asked, 鈥淲ho in this room has been taken to collections by UVA?鈥 said Matthew Gillikin, a speech therapist who was there. A quarter to a third of the people raised their hands, he said.
Court data analyzed by KHN showed that UVA Health was suing about 100 of its employees every year.
Also at the town meetings, 鈥渨e heard many agonizing stories of patients and employees having been sued or having wages garnished,鈥 Nadkarni said. 鈥淲e heard loud and clear from many physicians that they heavily supported significant liberalization鈥 of UVA Health鈥檚 financial assistance policies.
Family physician Dr. Alex Salomon, who worked at UVA for seven years and now is with Augusta Health in Fishersville, Va., had 鈥渁 lot of patients鈥 with UVA bill and lawsuit problems, many who had insurance but could not make out-of-pocket payments, he said. Still, he added, 鈥淚 didn鈥檛 realize UVA was so much worse鈥 than other hospitals.
As part of the University of Virginia, UVA Health is a state institution that is not subject to taxation. UVA Medical Center, the system鈥檚 flagship hospital, on revenue of $1.8 billion in the fiscal year ending in June and held stocks, bonds and other investments worth about $1 billion.
Doctors are realizing that financial barriers to treatment and budget squeezes from bills can be as harmful to patients as disease, said Dr. Marty Makary, a surgeon and researcher at Johns Hopkins Medicine who studies hospital debt collection and is urging UVA alumni to press for further change.
鈥淚 have not talked to a single patient or student of UVA or faculty member or alumni who thinks it is reasonable for the hospital to sue patients who cannot afford their bill,鈥 he said.
News of UVA collections practices served as a teaching moment for at least one class.
鈥淢any of the students in my class work for the UVA Health System, so the recent media coverage about UVA鈥檚 billing practices has been painful for them as nurses who care deeply about the patients and families they serve,鈥 Kimberly Acquaviva, a professor who teaches health policy at UVA鈥檚 nursing school, tweeted in September. 鈥淎s a class, we talked about the power that nurses have to shape the lives of the patients and families鈥 by advocating for system change, she said.
She declined a request for an interview, as did five other doctors or professors. Several referred a reporter to UVA spokesman Swensen. About 20 others did not respond to interview requests.
Dr. Chris Ghaemmaghami, an emergency and internal medicine doctor, became UVA Health鈥檚 acting CEO after Pamela Sutton-Wallace announced her resignation in September. Her departure was unrelated to KHN鈥檚 revelations, UVA said at the time.
鈥淚 understand the disappointment some fellow physicians felt when our historic billing and collection practices came to light,鈥 he said in an email responding to questions from KHN.
Heysell, Williams and Dillingham, the doctors who wrote the letter, go further.
鈥淭o be clear, we are outraged,鈥 they write. 鈥淲e stand with those that have been financially injured, whose bank accounts have been looted, whose homes have been swallowed as if they were built on quicksand, whose credit scores were ruined, and whose mental health and energy were spent in a courtroom or in anxious conversations with lawyers 鈥 all as a result of having sought our care.鈥
