RIP Medical Debt

**UPDATE: At the end of January, we learned that this donation has helped more than 110,000 patients in Mississippi and Louisiana by abolishing nearly $95 million in medical debt!  Visit RIP Medical Debt to learn just how far your own donation could go.**

If you or someone you know is struggling with medical debt, there are resources that might be able to help. Visit the Consumer Financial Protection Bureau to learn more.

By Farzad Mostashari, MD

A few years ago, I found myself poring over a printout with a doctor in a primary care practice in Mississippi. 

The sheet in front of us showed a number of patients who were frequenting the Emergency Department. All too often, the condition that brought them to the hospital could’ve been much more easily prevented or resolved in their primary care doctor’s office. The physician and I were brainstorming ways to help clinically re-engage with those patients when the office manager, an older woman who had seen her fair share of patient journeys, tossed some cold water on our medical takes.

“Hm,” she noted, looking at the list. “They’re not going to show their faces here. They all owe us money.”

I was stunned. Because she was right. They’d go to the emergency room. Because of the Emergency Medical Treatment & Labor Act, or EMTALA, they’d have to be seen. They’d be treated there, regardless of whether or not they could pay. And then they’d have to keep running from the medical debt those visits caused.

I looked at the list again. One patient might have owed just $84.

What happens when that patient, shamed for owing $84 to his primary care doctor, goes to the emergency room instead? Well first, he will have waited until his condition was so unbearable that he’ll drive – or someone will have to drive him – to the hospital. By then, even if his health and his life aren’t at risk, the condition will have only gotten more expensive to treat. He’ll rack up thousands of dollars more debt to the hospital, maybe even have to stay overnight. His bills will climb. His credit score will drop. It’ll be harder to get a new job to pay down the debt he has. It’ll be harder to get and keep stable housing. He might give up his phone number, to get away from threatening calls from collection agencies at all hours of the day and night. The stress and worry will only make his health worse – the very definition of a “social determinant of health”. And that’s not even touching on the effects all of this will have on his family and the people he loves. 

All of that because of $84. It’s enraging.

I’ve been obsessing over the issue of medical debt since then, and I highly recommend the entire #DiagnosisDebt series from NPR and Kaiser Health News. What a complete and utter indictment of the financial structures in our health care system. 100 million Americans hold some sort of medical debt. Four in every ten American adults say that they’ve delayed medically necessary care because of it. Black Americans face more aggressive debt collection and higher rates of medical defaults.  It’s a leading cause of bankruptcy. Chances are you know someone wrestling with this right now. 

The root causes of this debt are a gruesome dissection of our health care financing system – lack of access to primary care, uninsurance or under-insurance, generational poverty and structural racism, surprise medical billing, cost-shifting to “consumers”. While our action today isn’t attacking these upstream causes, we’re going to try to ameliorate the pain. In partnership with RIP Medical Debt, a national nonprofit focused on buying up and wiping out medical debt for patients in financial need all across the country, we are abolishing the debt of more than 110,000 patients in Louisiana and Mississippi – two states that bear the worst health outcomes in the country.

The economics of it are astounding. RIP Medical Debt – founded by two former debt collectors –  has figured out how to purchase and abolish debt at amazing rates. One single dollar can forgive about $100 of medical debt. For us, a few hundred thousand dollars in donations – matched by RIP, thanks to philanthropist MacKenzie Scott’s gift to the nonprofit, to further the impact of corporate donations – will wipe out more than $94 million. Financially, it’s an insane return-on-investment. But the biggest reason to do this is its alignment with our North Star: good for patients, good for practices, good for society.

The clinicians in Mississippi and Louisiana are doing heroic work. Every day, they fight an uphill battle against a rip tide of financial incentives that is dragging countless patients, families and whole communities out into the abyss. We’re honored that some of these clinicians are part of the Aledade network – and in the health outcomes they get for their patients. But they need our help. 

We recognize well that this is not going to help many of the patients we saw on the list that day. The debt we are retiring has already wrought many years of toxic harm, and tends to be what could readily be purchased from health systems and hospitals. We are actively working with RIP Medical Debt to explore ways in which we can aggregate and eliminate medical debt for qualifying patients who are seen in community primary care practices. We will be going upstream. Each patient with their debt retired will be a patient who can reconnect with their primary care doctor. They won’t have to worry about whether they’ll be able to pay the debt they’ve accumulated for getting primary care in the past. They can get a wellness visit, or ask a doctor about a recurring pain they’ve had without waiting until it’s become so severe or complicated that an ER visit is their only option.

We simply cannot tolerate being a society where medical debt keeps patients from staying healthy, and keeps our health care professionals striving to serve patients who are kept out of their reach by an overdue bill.