Hospitals must promptly report to the Los Angeles County Department of Public Health every time they try to collect medical debt from patients, under an ordinance backed Tuesday by county supervisors.

The ordinance, which requires a second vote to be adopted, requires hospitals to tell the county within a month or two of initiating debt collection, which can include making phone calls or mailing letters to seek payment more than 180 days after the initial billing, selling the debt to a collections agency, garnishing wages, seizing a bank account or informing a consumer reporting agency.

The new rules would also require hospitals to report up to four times annually on the medical debt amassed in recent months by their patients and what financial assistance they have offered them. If they fail to do so, they could face fines and legal action.

Public health officials said the rules would help shed light on hospital practices and address a crucial question: Where are the missed opportunities for hospitals to provide financial assistance?

Hospitals are supposed to provide financial aid to patients in need, but “the rub is the implementation,” said Dr. Anish Mahajan, chief deputy director of the L.A. County Department of Public Health. In a survey by the national nonprofit Dollar For, less than 30% of patients saddled with hospital bills they couldn’t afford said they had applied for and ultimately received financial assistance.

Many hospitals make good efforts to offer aid, Mahajan said, but data show “there is just so much medical debt — and that debt is disproportionately carried by poor people.”

Los Angeles County officials estimate that medical debt totaled more than $2.9 billion in the county in 2022, burdening 1 in 10 adults.

The public health department has launched an initiative to quash medical debt, including buying up and forgiving existing debt. In June, it set aside $5 million for a planned agreement with a nonprofit that erases such debts, which county officials estimated could eliminate $500 million of debt for 150,000 residents.

But the county has stressed that it also wants to prevent patients from incurring medical debt in the first place. Mahajan said that by pulling together information under the new ordinance, “we can then understand how hospitals are doing … in having their patients who should get financial assistance actually receive it.”

For instance, the county said it could match up data about patients whose medical bills were sent to collections to see if they might have been eligible for assistance, then reach out to hospitals about their findings.

“The goal is to help hospitals do better,” Mahajan said.

The figures could also help shed light on whether financial assistance is failing to reach particular groups of L.A. County residents, which could help guide future outreach and public education about the aid.

For instance, Mahajan suggested that in some cases, hospitals might have good policies on financial assistance, but some patients may fear seeking such aid amid worries about their immigration status.

Tackling such concerns could involve not just hospitals but other members of the county coalition that has sought to address medical debt, including legal aid and consumer groups, he said.

The mandatory reports could also give health facilities a sense of whether their financial assistance and debt collection practices fall outside the norm, compared with other hospitals in the area. Public health officials reported that hospitals across L.A. County provided more than $600 million in financial assistance in 2021, but more than half of it was from just four facilities — those run by the county itself.

Those safety net hospitals “can’t cover the entire county, and they’re doing the bulk of the financial assistance,” said Dr. Naman Shah, director of the division of medical and dental affairs at L.A. County Public Health. “The reason for this ordinance is that we can do better.”

Dr. Elaine Batchlor, chief executive of MLK Community Healthcare, told the county board that her Willowbrook hospital proactively takes steps to assess whether patients need aid, using software and other tools to check whether they are likely able to afford copays, then writing off the debt if their finances appear shaky.

Such financial tools “are widely available, and they’re not difficult to use,” Batchlor said Tuesday.

L.A. County will also put up a website where the public can peruse aggregate data about medical debt at local hospitals, although it is still determining exactly what information will be posted, Mahajan said.

The Hospital Assn. of Southern California said its members are deeply concerned about medical debt as an issue, but that the organization remains worried about some aspects of the county requirements.

In reaction to hospital concerns, the county has eased some rules surrounding how often reports must be provided, but “there still remain concerns about how voluminous” the data requirements will ultimately be, said Adena Tessler, the hospital association’s regional vice president for Los Angeles County.

For example, Tessler said that in some cases, hospitals might not be able to provide information because it hasn’t been provided by patients themselves. In addition, “the focus on hospitals remains a concern, because it’s just a piece of the medical debt issue.”

Public Health Director Barbara Ferrer said Tuesday that hospitals are a reasonable place to focus initially because “hospital bills comprise the majority of the debt and the largest bills.” Supervisor Janice Hahn added that “the work won’t stop here today” and that the county will be exploring how other entities — including insurance companies and private provider groups — play a role.

“Hospitals are not the sole cause of medical debt,” she said, “but starting there will help us develop a plan.”

Stanford University professor of economics Neale Mahoney applauded the effort, saying he hoped it would expand to other jurisdictions. “Medical debt is a dark corner in the U.S. healthcare system,” he said, and shining a light on it can be “a strong disinfectant.”

The L.A. County requirements would apply only to a small number of hospitals in unincorporated areas — county officials estimated the number at seven, including MLK Community Hospital — but local cities could adopt them to cover their jurisdictions as well. Hospitals will have roughly six months after the L.A. County ordinance goes into effect before failing to turn in the reports becomes a violation.

Tessler, of the hospital association, said that because the rules will be rolled out first in the unincorporated areas, her hope is that government officials will take the time to make sure that the reporting requirements make sense before expanding such rules to other parts of L.A. County.

Ferrer said her department would reassess the burdens of collecting such data in a year. In light of concerns about patient information, she said the portal that hospitals will use to provide information when they try to collect debt from individual patients is compliant with federal law on protecting patient privacy.

Batchlor, in her remarks Tuesday, described helping an uninsured friend diagnosed with cancer get the care she needed, only to recently learn that the woman was again uninsured because “she can now afford to either pay down her medical debt or pay the premiums for her health insurance — she can’t afford to do both.”

The hospital executive said that the “root cause of medical debt is the high cost of healthcare and the failure of health insurance to cover those costs.”

To solve the problem, she said, “we will ultimately need to address these root causes.”

Skateboarders call it “pumping,” and it’s a skill that both Olympic medalists and aspiring thrashers use to build launch speed from what seems like thin air.

But what separates the steeziest pro from the sketchiest beginner is the years’ worth of practice it takes to develop the know-how to execute the cleanest pump — or at least that was the case until now.

In a paper published Monday in the journal Physical Review Research, scientists have revealed the secret of achieving serious airtime.

With a bit of coding, researchers were able to describe the optimal technique for pumping — a tactic where skateboarders crouch down low momentarily and then push their body upright on inclines. To get the highest jump, they need to do it once as they descend into the bowl, and then again as they shoot back up toward the sky.

The trick is knowing when and where to execute the maneuver.

“Pumping is the foundation of skateboarding in skate parks,” said professional skater Haden McKenna, during a morning session at the Venice Beach Skatepark. “You build off of that and learn tricks. Then the pumping just becomes something in the back of your brain.”

However, the likeliest users of the researchers’ perfect pump equation are non-humans.

After skateboarding’s Olympic debut at the Tokyo Games, a research arm of the Japanese government reached out to Shigeru Shinomoto, a scientist at the Advanced Telecommunications Research Institute International in Japan. The organization had wondered if it was possible to build a skateboarding robot that could compete in the X Games.

The robot is still a ways off — right now it’s more like a toy that rides back and forth on a mini half-pipe — but the researchers discovered that the mechanics for good skateboarding technique can be surprisingly simple (well, at least compared to the complex fluid dynamics and neuroscience that they’re normally working on).

“It’s just this cute little project which became much bigger than we expected,” said Florian Kogelbauer, an author on the paper and a mechanical engineering professor at the public university ETH Zürich. “People like it — it’s a fun topic. It’s easy to explain, but some serious math and computational work went into it.”

To test their calculations, study authors recruited an expert skater with over a decade of experience, and a novice with just two years under their belt. They told the skaters to catch as much air as possible on a half-pipe erected in a research lab.

The result: The pro much more closely matched their calculated optimal motion than the amateur. (Ideally the skater would pop up instantaneously, but the researchers conceded that humans lack the unlimited muscle strength to do this — plus it would send the skater flying off their board.)

“The experiment seems to agree well,” said Frank Feng, a mechanical engineering professor at the University of Missouri who was not involved with the paper, but studied similar motions in half-pipe snowboarding.

Feng said the simple physics model gets researchers most of the way there, then the computer optimization is able to account for complexities that the physics equations can’t handle.

While the study was mostly just for fun, it snowballed into a fairly big project, and ended up getting published in one of the world’s premier physics journals. Part of the reason is that it may have some serious implications for how to get robots to move effectively without face-planting all the time.

It could help human skateboarders, too. Feng said the results could be used as a straightforward guide to help skateboarders train.

However, some question whether skaters would be able to use the information in the moment.

“This graph, showing the mass going up, is very helpful for somebody that can understand that,” said pro skater McKenna, who was not involved in the research. “But when you’re teaching kids and you’re trying to teach somebody that’s focused in the moment of skateboarding, they’re not going to be able to bring math into the equation.”

Also, out in the complex terrain of the park, the technique gets a bit more nuanced than a simple model the physicists developed. You need to flow as “one with the wall,” said McKenna. “Like what Bruce Lee says, ‘Be like water.’”

Skateboarder Greyson Godfrey, 20, of Rancho Santa Margarita drops into the bowl at Etnies Skate Park Lake Forest.

(Allen J. Schaben / Los Angeles Times)

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While the researchers’ optimal solution may not always be the best suited for real-world conditions, it does help to illustrate the physics behind the technique.

Studio Gutierrez, who teaches skateboarding as a sports instructor to middle schoolers in the Los Angeles Unified School District, finds understanding the science helpful for new skaters. “I explain it to them in physics motions,” he said. “The more motion, the faster you go, the higher you get.”

The physics works similarly to how ice skaters increase the speed of their spinning in the Winter Olympics, said Kogelbauer. They start out spinning slow with their limbs extended outward. Then, they tuck their arms and legs in, causing them to spin faster.

Skateboarders also gain speed by using this technique on curved surfaces.

When a skateboarder hits the circular section of the half-pipe, they start crouched down, positioning their center of mass further from the center of rotation above their head. As they climb the curved ramp, they pop up and bring their center of mass closer to the center of rotation, and they speed up.

While the pumping paper is one of the first to capture the physics of pumping, its authors aren’t the only ones studying the motion of skateboarding.

Google has also taken a stab at a more complex understanding with its Project Skate. It’s using AI to identify different tricks and motions — but AI requires a lot of computing power that many researchers who aren’t Google don’t have access to.

“They have [essentially] unlimited resources. If they want to, they can take a new server farm and then run trajectories as much as they want.” said Kogelbauer. “That’s what Google does. We’re not Google.”

If you’d like to study pumping physics on your own, you can tune in to the Paris Olympics. The women skateboarders are scheduled to compete in the park event (as opposed to the street event, which has fewer curved surfaces for pumping) Tuesday morning. The men are scheduled for Wednesday.

McKenna has always seen skating more as an art form and community than a sport, but he’s stoked to watch nonetheless. “When I was a kid, which doesn’t seem that long ago, skateboarding was a crime, literally,” he said. “Now we’re winning gold medals in the Olympics.”

A Summer Olympics that hoped to champion inclusivity — choosing “Games Wide Open” as its slogan — has become embroiled in loud, angry debates over who should and should not be allowed to compete as a woman.

The dispute has triggered conflicting official statements, pointed comments and unhinged social media posts, all whirling around two athletes in the women’s boxing competition at Arena Paris Nord.

This isn’t about how Imane Khelif of Algeria and Lin Yu Ting of Taiwan identify. By all accounts, they were born as women but appear to have unusual body chemistry that triggered gender tests and caused them to be disqualified from last year’s world championships.

The Olympics, however, have broader eligibility rules.

“I think we all have a responsibility to dial down this and not turn it into some kind of witch hunt,” International Olympic Committee spokesman Mark Adams told reporters. “These are regular athletes who have competed for many years in boxing, they are entirely eligible and they are women on their passports.”

His plea has been overshadowed by a Thursday afternoon bout in which Khelif punched an opponent hard enough to make her quit after 46 seconds. Paris has been lumped in the same category as previous controversies involving South African runner Caster Semenya and U.S. collegiate swimmer Lia Thomas.

This case might be more incendiary because, instead of running or swimming fast, Khelif and Lin are delivering potentially lethal blows. Italian boxer Angela Carini said she conceded to Khelif because “I had to safeguard my life.”

Experts wonder if the sports world has reached an inflection point.

“We really have not come up with a consensus on how we define sex,” said Jaime Schultz, author of a new book titled “Regulating Bodies: Elite Sport Policies and Their Unintended Consequences.” “People have to learn how to talk about this.”

Over the last 24 hours, much of the public discourse has inaccurately described Khelif and Lin as transgender. Former President Donald Trump posted on Truth Social: “I WILL KEEP MEN OUT OF WOMEN’S SPORTS!”

There is no evidence that either boxer is transgender or has chromosomal abnormalities. Though purposefully vague, officials have described what appear to be “differences of sex development,” a designation that applies to women who are androgen-sensitive or have naturally occurring testosterone levels in the male range.

The international track federation used this standard to demand that 800-meter star Semenya either take medication to alter her body chemistry or race against men. She fought the decision, losing in the Federal Supreme Court of Switzerland.

Sports have a long and troubled history with gender testing.

Early on, female athletes were forced to disrobe for physical inspections. Chromosome tests came into fashion for a while but were successfully challenged by Spanish runner Maria Jose Martinez-Patino in the 1980s because they could not account for rare conditions.

Though testosterone is now a common measure, there is continued disagreement over its validity.

Italy’s Angela Carini, left, cries after her loss to Algeria’s Imane Khelif at the Paris Olympics on Thursday.

(John Locher / Associated Press)

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“These criteria keep folding under the weight of closer scrutiny,” said Schultz, who is also a kinesiology professor at Penn State. “None of them have held up over time.”

Veterans on the amateur scene, Khelif finished fifth in the 60 kilogram event and Lin finished ninth at 57 kilograms in the Tokyo Olympics in 2021. The Algerian won silver at the International Boxing Assn.’s 2022 world championships. The Taiwanese athlete earned gold at that tournament in 2018 and 2022.

But last year, the IBA took action against both women.

Khelif was disqualified shortly before her gold-medal bout and Lin after her bronze-medal victory. The IBA stated the boxers did not “undergo a testosterone examination but were subject to a separate and recognized test, whereby the specifics remain confidential.”

The situation grew more complicated when the IOC suspended its recognition of the IBA after years of dispute between the organizations. With the IOC temporarily in control of boxing at the Games, Khelif and Lin have had their eligibility restored.

It came as no surprise when Khelif’s bout on Thursday prompted dueling responses.

First the IBA condemned Olympic officials for letting Khelif and Lin compete, stating: “We absolutely do not understand why any organization would put a boxer at risk with what could bring a potential serious injury.”

The IOC fired back by saying: “Every person has the right to practice sport without discrimination.” It further noted the IBA disqualifications were “based entirely on this arbitrary decision, which was taken without any proper procedure.”

Algeria’s Imane Khelif, right, walks beside Italy’s Angela Carini after their women’s 66kg preliminary boxing match.

(John Locher / Associated Press)

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On Friday morning, when questioned about the Olympics’ apparent struggle with gender rules, Adams said: “There is still neither scientific nor political consensus on this issue. It’s not a black and white issue. And we at the IOC would be very interested to hear of such a solution, such a consensus on this, and we would be the first to act on this should a common understanding be reached.”

Hours later, the media descended on a bout between Lin and Sitora Turdibekova of Uzbekistan. No devastating blows were landed during Lin’s victory, by unanimous decision, after which both athletes walked through the mixed zone without responding to questions.

Khelif’s next bout — against Anna Luca Hamori of Hungary — figures to attract similar attention on Saturday. The Hungarian Boxing Assn. has reportedly protested Khelif’s participation but Hamori did not seem as concerned. “I am not scared,” the boxer said. “If she or he is a man, it will be a bigger victory for me if I win. So let’s do it.”

Even Carini, who fell to her knees and cried after losing to Khelif, has been magnanimous. Her comments reflect the complexity of the issue.

“I am not in the position of saying this is right or wrong,” she told reporters. “I did my job as a boxer, entering the ring and fighting.”