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As University Hospital Hounds Debtors, Doctors Say It's Doing Harm


In recent months, doctors at the University of Virginia Health System discovered something that shocked them. Over several years, UVA had been suing some 36,000 patients who had unpaid medical bills. UVA was going after their wages and savings and even driving some into bankruptcy. So some UVA doctors decided to publicly push back. Dr. Michael Williams is one of them, and he joins us now.

Good morning.

MICHAEL WILLIAMS: Good morning to you.

GARCIA-NAVARRO: So you and some of your colleagues went public in a letter to Kaiser Health News. You said UVA's billing practices violate the oldest ethic of Western medical practice, the Hippocratic oath that says, first, do no harm. Can you explain that?

WILLIAMS: Yes. Well, all of us take that oath very seriously. I can think of no physician who doesn't. And so to find out that patients for whom we had prescribed therapies, performed surgeries, conducted procedures and the like were being sued, up to and including the point of taking their homes, felt like a betrayal to those of us who signed the letter and many others here.

GARCIA-NAVARRO: How did you learn about this?

WILLIAMS: Well, we learned about the rest - the way, I think, the rest of the world did. There was the story that broke in Kaiser Health News. And none of the faculty that I know were aware of the depth and breadth of the situation and/or how much harm had been done.

GARCIA-NAVARRO: Shouldn't you have known sooner that this was happening since this is a place where you work?

WILLIAMS: Yes. Well, it is - yes. It is one of the more complex systems that you'll come across. The physicians at UVA, like many other health systems, actually don't work for the medical center. It's a separate business entity. So we are, as physicians, not privy to the billing and collection practices of the hospital.

So on the one hand, we currently have no mechanism by which to know this information. On the other hand, I have to agree with you. It is incumbent upon us as physicians to educate ourselves on these matters and other things that are similar to - things that can cause harm like this.

GARCIA-NAVARRO: So what should be different about how UVA goes after people who owe it money?

WILLIAMS: UVA will still have to go out people who owe the system money. There is no other way to describe the U.S. health care system currently as anything but a business. We - I'll speak for myself - are in favor of loosening the level of aggression with which we pursue outstanding accounts and certainly the elimination of lawsuits. I would rather see the health system and the practice group collectively understand our patients' context and then probably make different choices based on that context.

GARCIA-NAVARRO: I was about to ask, Dr. Williams, does that mean that you might prescribe things differently? What impact could that have on your patients' health and the choices that they may make?

WILLIAMS: I think in doing no harm, we also need to be into - weigh the balance of the financial harm that we will incur if we prescribe a specific course of action or therapy. We physicians need to, in my view, say, what are cost-effective, as well as clinically effective, therapies that can be offered that will achieve the patient's clinical outcome that we're looking for together and yet take into mind the patient's - as I said, their context?

GARCIA-NAVARRO: The university has responded with two changes. They will screen out or go easier on a wider range of debtors, and they've established an advisory group to overhaul their billing practices. Do you think it's enough?

WILLIAMS: Well, the - I think it's not enough. I think it's a good beginning. I think having community voice as part of this conversation is essential. But as I said, both patients and physicians have to understand the economics of this whole business that we're in together.

GARCIA-NAVARRO: Listening to you talk about this, I can't help but think that this puts an additional burden on doctors, who are already - if you speak to doctors - overburdened with a lot of different paperwork and having to think about patients. I mean, does that not add an extra layer to what you do?

WILLIAMS: Absolutely. And that's the job. We have become safe when it comes to infections related to catheters. And we've become safe when it comes to patients who fall. We've become safer when it comes to things like sharp injuries from needles and sutures and the like. If we continue to cause financial harm to this degree, we have rendered our patients no safer.

GARCIA-NAVARRO: Dr. Michael Williams is a surgeon and head of the UVA Center for Health Policy. Thank you very much.

WILLIAMS: Thank you for having me. Transcript provided by NPR, Copyright NPR.

Lulu Garcia-Navarro is the host of Weekend Edition Sunday and one of the hosts of NPR's morning news podcast Up First. She is infamous in the IT department of NPR for losing laptops to bullets, hurricanes, and bomb blasts.