Nashville General Hospital is a safety-net facility funded by the Tennessee capital city. For a patient without insurance, this is supposed to be the best place to go in a city with many hospitals. But for the uninsured, it may have been the worst choice in 2019.
Its emergency room was taking more patients to court for unpaid medical bills than any other hospital or practice in town. A WPLN investigation found the physician-staffing firm that runs the ER sued 700 patients in Davidson County during 2019.
They include patients such as Sonya Johnson, a 52-year-old social worker and single mother. By juggling her care between a nonprofit clinic and Nashville General, Johnson had figured out how to manage her health problems, even though she was, until recently, uninsured.
In 2018, she went to see her doctor, who charges patients on a sliding scale. Her tongue was swollen and she was feeling weak. The diagnosis? Severe anemia.
“He called me back that Halloween day and said, ‘I need you to get to the emergency [room], stat — and they’re waiting on you when you get there,’” she recalled.
Nashville General kept her overnight and gave her a blood transfusion. They wanted to keep her a second night — but she was worried about the mounting cost and asked to be sent home.
Staying the one night meant she was admitted to the hospital itself, and the bill for that part of her care wasn’t so bad, Johnson said. The institution’s financial counselors offered a 75% discount because of her strained finances and because her job didn’t offer health insurance at the time.
But emergency rooms are often run by an entirely separate entity. In Nashville General’s case, the proprietor was a company called Southeastern Emergency Physicians. And that’s the name on a bill that showed up in Johnson’s mailbox months later for $2,700.
“How in the world can I pay this company, when I couldn’t even pay for health care [insurance]?” Johnson asked.
Johnson didn’t recognize the name of the physician practice. A Google search didn’t help much. There’s no particular website, though a listing of webpages that do turn up in such a search suggests the company staffs a number of emergency departments in the region.
Johnson said she tried calling the number listed on her bill to see if she could get the same charity-care discount the hospital gave her, but she could only leave messages. And then came a knock at her apartment door over the summer. It was a Davidson County sheriff’s deputy with a summons requiring Johnson to appear in court.
“It’s very scary,” she said, and she recalled thinking “What have I done? And for a medical bill?”
Handoff of Lawsuits?
Being sued over medical debt can be a big deal because it means a business can get a court-ordered judgment to garnish patients’ wages, taking money directly from their paycheck. The strategy is meant to make sure patients don’t blow off their medical debts. But this is not good for the health of people who are uninsured, said Bruce Naremore, chief financial officer at Nashville General.
“When patients owe money, and they feel like they’re being dunned all the time, they don’t come back to the hospital to get what they might need,” he said.
Under Naremore’s direction in the past few years, Nashville General had stopped suing patients for hospital fees. He said it was rarely worth the court costs.
But Southeastern Emergency Physicians — which, since 2016, has been contracted by the hospital to run and staff its emergency department — went the other way, filing more lawsuits against patients than ever in 2019.
Naremore said the decision on whether to sue over emergency care falls to the company that staffs the ER, not Nashville General Hospital.
“It’s a private entity that runs the emergency room, and it’s the cost of doing business,” he said. “If I restrict them from collecting dollars, then my cost is going to very likely go up, or I’m going to have to find another provider to do it.”
This is a common refrain, said Robert Goff, a retired hospital executive and board member of RIP Medical Debt. The nonprofit helps patients trapped under a mountain of medical bills, which are the No. 1 cause of personal bankruptcy.
“So the hospital sits there and says, ‘Not my problem.’ That’s irresponsible in every sense of the word,” Goff said.
The practice of suing patients isn’t new for Southeastern Emergency Physicians or its parent company, Knoxville, Tennessee-based TeamHealth. But such lawsuits have picked up in recent years, even as the company has stopped its practice of balance-billing patients.
TeamHealth is one of the two dominant ER staffing firms in the nation, running nearly 1 in 10 emergency departments in the United States. And its strategy of taking patients to court ramped up after it was purchased by the private equity giant Blackstone, according to an investigation by the journalism project MLK50 in Memphis, Tennessee.
Under pressure from journalists, TeamHealth ultimately pledged to stop suing patients and to offer generous discounts to uninsured patients.
Officials from TeamHealth declined WPLN’s request for an interview to answer questions about how widespread its practice of suing patients for ER doctors’ services and fees has been.
“We will work with patients on a case by case basis to reach a resolution,” TeamHealth said in an email.
According to court records obtained by WPLN, the firm filed about 700 lawsuits against patients in Nashville in 2019. That’s up from 120 in 2018 and just seven in 2017. Its only contract in the city is with Nashville General’s ER, and the patients reached by WPLN said they were uninsured when they were sued.
What’s surprising to Mandy Pellegrin, who has researched medical billing in Tennessee at the nonpartisan Sycamore Institute, is that it was all happening at Nashville General — where treating uninsured patients is part of the hospital’s mission.
“It is curious that a company that works for a hospital like that might resort to those sorts of actions,” Pellegrin said.
A Pledge to Drop Cases
As for Sonya Johnson — she eventually went to court and worked out a payment plan of $70 a month over three years.
And now TeamHealth tells WPLN that its intent is to drop pending cases.
“We will not file additional cases naming patients as defendants and will not seek further judgments,” a TeamHealth spokesperson said in an emailed statement. “Our intent is not to have these pending cases proceed. We’re working as expeditiously as possible on resolving individual outstanding cases.”
Johnson said she has been told that the lawsuit Southeastern Emergency Physicians filed against her will be dropped — but that she still owes the $2,700 bill.
This story is part of a reporting partnership that includes WPLN, NPR and Kaiser Health News.