Tuesday, April 25, 2017

Community Health Advisors Featured in Selected News Articles

September 2016  Pittsburgh Post-Gazette   Hospitals Turn Bad Debt Into Charity Care - Mark Rukavina, an expert on medical debt who consults to hospitals, said some of the early versions of the presumptive eligibility tools were the result of a series of lawsuits filed against non-profit hospitals in 2004 across the country.  

March 2016 Kaiser Health News  Mortgages For Expensive Health Care?  Some Experts Think It Can Work  -   “Isn’t this why we have health insurance?” asked Mark Rukavina, a Boston-based health care consultant whose work has focused on affordability and medical debt. “Insurance used to protect people from financial ruin for these unpredictable, costly occurrences."

March 2016 Times Free Press  Patients And Hospitals Struggle With Rising Cost Of Care In Chattanooga Area -  "Health care costs have outstripped inflation, wage gains and the consumer price index, year after year," said Mark Rukavina, founder of Community Health Advisers, which advises hospitals on how to work with consumers to help them pay their bills.

September 2015   The New York Times  How to Manage Increasingly Higher Medical Deductibles  -  Despite recent gains in the number of Americans who have health insurance, many people are still faced with paying for care out of pocket because of high deductibles.   “Be sure you can really afford a plan with a high deductible — especially if you have chronic condition that requires more frequent doctor visits or tests,”  said Mark Rukavina, a health care consultant in Boston.

June 2015  Credit.com:  Unconscious & Cost-Conscious: The Plight of an Uninsured Hospital Patient - See my post discussing the recent study that found there are enormous variations across hospitals in terms of what they charge. The study generated headlines accusing hospitals of charging the uninsured more than 10 times the cost of care.  The post calls for improved transparency on prices and financial assistance offered by both not-for-profit and for-profit hospitals.

May 2015  Wall Street Journal:  Health Costs Hinge on Supreme Court Ruling  - The court is expected by the end of June to rule on a lawsuit seeking to invalidate subsidies to more than 7.5 million people who bought plans on the federal exchange. If the court upholds the lawsuit, those people will land in the same boat as their more well-heeled compatriots

“For many people getting coverage through the marketplaces, the combination of premiums and out-of-pocket expenses is going to be quite significant, maybe crushing for some people,” said Mark Rukavina,  founder of Community Health Advisors LLC, a Chestnut Hill, Mass.-based health consultancy.

May 2015 Nasdaq.com: Retirees, Find Hospitals That Score High  - Choosing a good hospital shouldn't seem all that difficult. If you are facing surgery or another procedure, you can seek the advice of your doctor, family and friends. But consumers who want to dig deeper -- delving into hospitals' quality, safety and affordability -- can quickly become confused and concerned.

You need to determine whether the hospital is covered by your health-insurance plan and whether everyone involved in your care there is within your plan's network. "This is more difficult than it might sound," says Mark Rukavina, principal at Community Health Advisors, in Boston.

March 2015 Consumer Reports: Smart ways to borrow - Know the difference between good and bad debt to save and make money - Debt has gotten a bad rap for a very long time. But used correctly, debt is a powerful way to build wealth. The goal is to pursue good debt—borrowing to help improve your financial prospects—and avoid bad debt, for unnecessary expenses. All the more power to you if the debt you choose is tax-favored and payments are deferred.

Paying medical bills:  Mandated health insurance for all Americans means that in theory most people will no longer face extreme health care bills of hundreds of thousands of dollars. There are limits on the out-of-pocket costs for plans purchased through state insurance marketplaces.

Before shouldering any medical debt, make sure the health provider hasn’t made billing mistakes that have run up your bill. Such errors are common, according to Mark Rukavina, principal at Community Health Advisors, a health care consultancy. Question charges, and ask whether the provider offers financial assistance. Nonprofit hospitals are required to have financial-­assistance policies; many other providers have them, too.

March 2015 New York Times: TransUnion, Equifax and Experian Agree to Overhaul Credit Reporting Practices - The nation’s giant credit reporting agencies have agreed to overhaul their approach to fixing errors and their treatment of medical debts on consumers’ reports.  New York State Attorney General Eric Schneiderman announced that his office had reached a sweeping settlement with the agencies, affecting consumers nationwide.  The credit bureaus — Experion, Equifax and TransUnion —will improve their dispute resolution process, and also establish a six-month waiting period before reporting medical debts on consumers’ credit reports providing more time for consumers to resolve issues that might amount only to a delayed insurance payment or another dispute. The credit agencies will also remove medical debts from an individual’s report after the debt is paid by insurance.

Requiring the credit bureaus to wait 180 days to list any delinquent medical debt on credit reports is another victory for consumers. Given the complex way in which medical bills are charged and paid, it is not uncommon for delays in payment to tarnish credit reports, often without consumers’ knowledge.   

“Too many people are surprised to learn of medical billing problems only after having a bill sent to collection and being forced to deal with damaged credit,” said Mark Rukavina, a longtime consumer advocate and principal of Community Health Advisors, a consultancy that works with nonprofit hospitals on billing and collection issues. “Having the agencies finally agree to remove medical debts that were reported and subsequently paid by insurers is long overdue.”

February 2015 New York Times: Insured but Not Covered:  It is true that the Affordable Care Act has erased some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills. Insurers can no longer deny coverage to those with pre-existing conditions, for example. And the new policies cap out-of-pocket spending so long as the patient receives care within the plan. Most important, the act has offered health insurance to an estimated 10 million Americans who did not have any, often by expanding Medicaid or providing subsidies.

But by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.

“A big part of the way they’ve kept premiums down is to shift costs to patients in the form of co-pays and deductibles and other types of out-of-pocket expenses. And that can leave patients very vulnerable,” said Mark Rukavina of Community Health Advisors. 

February 2015 USA Today: Consumers Still Struggling with Medical Debt:  When calling for the Affordable Care Act’s  passage, President Obama declared people shouldn't "go broke because they get sick."  This article examines whether the ACA, the federal health law intended to keep a surprise illness or injury from bankrupting Americans, has effectively address the problem of medical debt. 

“Some of the forces that were in play prior to the passage of the Affordable Care Act are still in play," said Mark Rukavina, who founded Community Health Advisors,  a group that advises providers on how to comply with federal regulations.

January 2015 The Tennessean: Medical debt takes financial toll on Tennesseans:   Nearly one in three Tennessee adults had outstanding medical debt — unpaid bills after insurance payment or the full cost without insurance — in 2012, a rate that ranks it seventh in the country, tied with three other states, according to the FINRA Investor Education Foundation.   The incidence of medical debt is challenging to quantify. Data is pulled from bankruptcy records, credit reports and collection agency data. 

But its impact on households is staggering. "The issue of medical bills on credit reports can ruin" people down the road when trying to buy a car, get a home loan or credit card, said Mark Rukavina, founder of Community Health Advisors, a healthcare advisory firm in Chestnut Hill, Mass. "It's a serious headache."  In other cases, people buy plans with low premiums to save money each month, taking the risk that they won't be in the situation to pay the higher deductible. A $2,000 deductible can be overwhelming for many people, noted Rukavina.

December 2014 National Public Radio & Propublica – When Nonprofit Hospitals Sue Their Poorest Patients:  NPR and ProPublica looked specifically at nonprofit hospitals and found the practice of wage garnishment to be widespread in five different states around the country.  The report stated that nonprofit hospitals get huge tax breaks — they are considered charities and therefore don't pay federal or state income tax or local property tax. In exchange, they are obligated to provide financial assistance or "charity care" to lower-income patients.

If a nonprofit hospital gets too aggressive with debt collection these days, "they're putting at risk their federal tax exemption," says Mark Rukavina. He runs Community Health Advisors, a consulting firm that helps hospitals comply with the Affordable Care Act.  The ACA actually sets a new and higher standard for debt collection.  "The statute is quite clear," Rukavina says. "It says nonprofit hospitals should not engage in extraordinary collection actions before making a reasonable effort to determine whether someone is eligible for financial assistance."

December 2014 Nasdaq.com: CFPB moves to soften medical debt's impact:  The federal Consumer Financial Protection Bureau released a report on medical collections at a Dec 11th hearing.  It described medical debt as different from other types of debt and found that medical debt affects nearly one of every five consumers with a credit report.  The study was critical of unclear and confusing medical collection practices.

"It's hard for consumers to navigate the medical debt maze and come out with a clean credit report on the other side,'' .Richard Cordray, director of the U.S. Consumer Financial Protection Bureau.

A panelist at the hearing, Mark Rukavina, principal of Community Health Advisors LLC, noted one way health care costs are unique: "Sometimes people are actually unconscious when they incur these bills."

The financial protection bureau lacks jurisdiction over hospitals and doctors, but it can influence their billing practices via rules on credit bureaus and debt collectors.


January 2016 -  The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey:  This survey provides an in-depth look at the experiences of Americans ages 18-64 who say they or someone in their household had problems paying medical bills in the past year.  The survey explores the causes of medical bill problems and the impacts they have on individuals and their families, finances, and access to health care.


January 2015 - The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014:  New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act's subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties.


December 2014 Consumer Financial Protection Bureau Report Spotlights Concerns with Medical Debt Collection and Reporting:  The Consumer Financial Protection Bureau report that found medical debt has a significant impact on consumer credit, as 43 million Americans have overdue medical debt on their credit reports. The CFPB is concerned that the systems for incurring, collecting, and reporting medical debt can create difficult challenges for consumers. To better address these challenges, the CFPB announced that the major consumer reporting agencies will be required to provide regular accuracy reports to the Bureau on how disputes from consumers are being handled.

"It's hard for consumers to navigate the medical debt maze and come out with a clean credit report on the other side,” said CFPB Director Richard Cordray. “The CFPB is taking action to improve credit report accuracy. Getting medical care should not make your credit report sick.”

The report, “Consumer credit reports: A study of medical and non-medical collections can be found at: http://files.consumerfinance.gov/f/201412_cfpb_reports_consumer-credit-medical-and-non-medical-collections.pdf

May 2014 Consumer Financial Protection Bureau Study Finds Medical Debt Overly Penalizes Consumer Credit Scores:   Consumer Financial Protection Bureau releases a study on how the collection of medical debt affects a consumer’s credit score.  The study found that consumers’ credit scores may be overly penalized for medical debt that goes into collections and shows up on their credit report.  This is because credit scoring models may be underestimating the creditworthiness of consumers who owe and pay back medical debt in collections.

The study, “CFPB Data Point: Medical Debt and Credit Scores,” can be found at: http://www.consumerfinance.gov/reports/data-point-medical-debt-and-credit-scores/

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