No More ‘Grateful Patient’ Bonuses; Med School Cheating Saga; Junk Insurance Fallout

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Docs Won’t Get Bonuses for Fundraiser Referrals

Jefferson Health has changed course when it comes to a policy that linked some doctors’ bonuses to their referrals of patients to the health system’s fundraising office, The Philadelphia Inquirer reported.

Grateful patient fundraising, steering patients who have expressed gratitude for care to a health system’s fundraising office in the hope they’ll give money, isn’t new, The Inquirer noted. However, earlier this year several Jefferson Health doctors called attention to their concern when the health system linked those referrals to incentive pay, the outlet reported.

“After receiving internal feedback, Jefferson has gone back to the original grateful patient referral program, which does not have an incentive component,” John Brand, Jefferson’s chief communications officer, told The Inquirer.

The outlet reported that Jefferson Health’s reversal comes on the heels of The Inquirer’s February report that some of the health system’s doctors were “being asked to refer at least one ‘grateful’ patient each month,” and that efforts could affect their annual bonus.

Patients had also expressed their alarm over the policy.

After reading The Inquirer’s initial reporting on the issue, Steven Cohen, PhD, a Southampton psychologist and Jefferson Health patient, sent a letter to the hospital’s CEO, the outlet reported.

“All patients should have the assurance that when they receive care the health-care provider is focused on the diagnosis and treatment and is not burdened by any conflicts of interest imposed by the employer,” Cohen told The Inquirer after Jefferson Health walked back its policy.

Questionable Cheating Allegations Rile Medical Students

At Dartmouth’s Geisel School of Medicine, 17 students have been accused of cheating on remote exams while in-person tests were shut down due to COVID-19, according to a New York Times report. But the finger-pointing hasn’t been without backlash.

“The allegations have prompted an on-campus protest, letters of concern to school administrators from more than two dozen faculty members, and complaints of unfair treatment from the student government,” The Times reported, “turning the pastoral Ivy League campus into a national battleground over escalating school surveillance during the pandemic.”

Dartmouth’s use of a technology system called Canvas to retroactively track students’ activity during remote exams without their knowledge is at the center of the debate. The process may have led to erroneous allegations, The Times wrote, citing technology experts, a review of the software code, and school documents it obtained.

“If other schools follow the precedent that Dartmouth is setting here, any student can be accused based on the flimsiest technical evidence,” Cooper Quintin, senior staff technologist at the digital rights organization Electronic Frontier Foundation, told The Times.

Though seven of the accused students have had their cases dismissed, the other 10 have been expelled, suspended, or received course failures and unprofessional conduct marks on their records, according to the report. Such consequences “could curtail their medical careers,” the outlet wrote.

‘Junk Insurance’ Stuck Patient with $33,000 Bill

When Cory Dowd was diagnosed with appendicitis last summer and had an appendectomy, he never imagined his final hospital statement would show his insurance paid just $1,682 for the procedure, leaving him on the hook for $33,600. But that’s exactly what happened, ProPublica reported.

In 2019, Dowd — a self-employed event planner in between a Peace Corps stint and graduate school — turned to the internet to shop for insurance, ProPublica reported. “But the individual insurance market he was about to enter was one dramatically changed under President Donald Trump’s push to dismantle Obamacare, offering more choices at cheaper prices,” the outlet wrote.

The short-term plans that Dowd signed up for aren’t beholden to the Affordable Care Act’s (ACA) strict coverage rules and have been called “‘junk insurance'” by both consumer advocates and health policy experts. “The plans can deny coverage for people with preexisting conditions, exclude payments for common treatments and impose limits on how much is paid for care,” ProPublica wrote.

But Dowd and millions of others have only seen what they believe to be a good deal, according to the ProPublica report. And the Biden administration now faces a challenge when it comes to the proliferation of short-term plans.

The American Rescue Plan includes an extension of the special enrollment period to sign up for ACA-compliant plans, subsidizes COBRA payments, and expands federal assistance to lower ACA plan premiums, ProPublica reported. But some experts worry that may not be enough, especially for people who haven’t yet realized the limits of non-ACA-compliant plans.

“It will take the same level of intentionality that got people on these plans to get them off of them,” Dorianne Mason, director of health equity for the National Women’s Law Center, told ProPublica.

After an appeal, Dowd’s insurer ultimately paid $32,772 for his procedure, with the hospital waiving the remaining amount.