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This Nonprofit Health System Cuts Off Patients With Medical Debt

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This Nonprofit Health System Cuts Off Patients With Medical Debt

Many hospitals in the United States use aggressive tactics to collect medical debt. They flood local courts with collections lawsuits. They garnish patients’ wages. They seize their tax refunds.

But a wealthy nonprofit health system in the Midwest is among those taking things a step further: withholding care from patients who have unpaid medical bills.

Allina Health System, which runs more than 100 hospitals and clinics in Minnesota and Wisconsin and brings in $4 billion a year in revenue, sometimes rejects patients who are deep in debt, according to internal documents and interviews with doctors, nurses and patients.

Although Allina’s hospitals will treat anyone in emergency rooms, other services can be cut off for indebted patients, including children and those with chronic illnesses like diabetes and depression. Patients aren’t allowed back until they pay off their debt entirely.

Nonprofit hospitals like Allina get enormous tax breaks in exchange for providing care for the poorest people in their communities. But a New York Times investigation last year found that over the past several decades, nonprofits have fallen short of their charitable missions, with few consequences.

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Allina has an explicit policy for cutting off patients who owe money for services they received at the health system’s 90 clinics. A 12-page document reviewed by The Times instructs Allina’s staff on how to cancel appointments for patients with at least $4,500 of unpaid debt. The policy walks through how to lock their electronic health records so that staffers cannot schedule future appointments.

“These are the poorest patients who have the most severe medical problems,” said Matt Hoffman, an Allina primary care doctor in Vadnais Heights, Minn. “These are the patients that need our care the most.”

Allina Health said it has a robust financial assistance program that in an average year helps over 12,000 of its 1.9 million patients with medical bills. The hospital system cuts off patients only if they have racked up at least $1,500 of unpaid debt three separate times. It contacts them by phone and with repeated letters that include information about applying for financial help, said Conny Bergerson, a hospital spokeswoman.

“Allina Health’s goal is, and will always be, to have zero patients go without services for financial reasons,” Ms. Bergerson said. She said that cutting off services was “rare” but declined to provide information on how often it happens.

Allina suspended its policy of cutting off patients in March 2020, at the onset of the coronavirus pandemic, before reinstating it in April 2021.

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An estimated 100 million Americans have medical debts. Their bills make up about half of all outstanding debt in the country.

About 20 percent of hospitals nationwide have debt-collection policies that allow them to cancel care, according to an investigation last year by KFF Health News. Many of those are nonprofits. The government does not track how often hospitals withhold care.

Under federal law, hospitals are required to treat everyone who comes to the emergency room, regardless of their ability to pay. But the law — called the Emergency Medical Treatment and Labor Act — is silent on how health systems should treat patients who need other kinds of lifesaving care, like those with aggressive cancers or diabetes.

In 2020, thanks to its nonprofit status, Allina avoided roughly $266 million in state, local and federal taxes, according to the Lown Institute, a think tank that studies health care.

In exchange, the Internal Revenue Service requires Allina and thousands of other nonprofit hospital systems to benefit their local communities, including by providing free or reduced-cost care to patients with low incomes.

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But the federal rules do not dictate how poor a patient needs to be to qualify for free care. In 2020, Allina spent less than half of 1 percent of its expenses on charity care, well below the nationwide average of about 2 percent for nonprofit hospitals, according to an analysis of hospital financial filings by Ge Bai, a professor at the Johns Hopkins Bloomberg School of Public Health.

Allina is one of Minnesota’s largest health systems, having largely grown through acquisitions. Since 2013, its annual profits have ranged from $30 million to $380 million. Last year was the first in the past decade when it lost money, largely owing to investment losses.

The financial success has paid dividends. Allina’s president earned $3.5 million in 2021, the most recent year for which data is available. The health system recently built a $12 million conference center.

Yet Allina sometimes plays hardball with patients. Doctors have become accustomed to seeing messages in the electronic medical record notifying them that a patient “will no longer be eligible to receive care” because of “unpaid medical balances.”

Dr. Rita Raverty, a primary care doctor who works at an Allina clinic, said the notifications were alarming because they meant she could not provide continuous care for some of her patients facing a number of health risks.

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“Nobody wins when patients can’t get preventive care,” Dr. Raverty said. “It creates worse disease outcomes when you’re not catching things early.”

Doctors and patients described being unable to complete medical forms that children needed to enroll in day care or show proof of vaccination for school.

Serena Gragert, who worked as a scheduler at an Allina clinic in Minneapolis until 2021, said the computer system simply wouldn’t let her book future appointments for some patients with outstanding balances.

Ms. Gragert and other Allina employees said some of the patients who were kicked out had incomes low enough to qualify for Medicaid, the federal-state insurance program for poor people. That also means those patients would be eligible for free care under Allina’s own financial assistance policy — something many patients are unaware exists when they seek treatment.

Ms. Bergerson, the Allina spokeswoman, did not dispute that but said the health system goes “to tremendous lengths to assist patients with their financial obligations for medical care.”

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Allina employees said the policy has forced them to ration care.

Beth Gunhus, a pediatric nurse practitioner, recalled a case in which a mother brought in her three children. One had scabies, an intensely itchy skin condition caused by mites burrowing into the body. She wanted to follow best practices and treat the entire family, who were sharing one bed in a single room they rented, to ensure it didn’t spread further. But she could write a prescription for only two of the children. The third’s account was locked because of unpaid bills.

“There are so many better ways of saving money than what we’re doing,” Ms. Gunhus said.

Allina says the policy applies only to debts related to care provided by its clinics, not its hospitals. But patients said in interviews that they got cut off after falling into debt for services they received at Allina’s hospitals.

Because Allina is the dominant health system in some rural parts of Minnesota, getting kicked out can leave patients with few options.

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Jennifer Blaido lives in Isanti, a small town outside Minneapolis, and Allina owns the only hospital there. Ms. Blaido, a mechanic, said she racked up nearly $200,000 in bills from a two-week stay at Allina’s Mercy Hospital in 2009 for complications from pneumonia, along with several visits to the emergency department for asthma flare-ups. Ms. Blaido, a mother of four, said most of the hospital stay was not covered by her health insurance and she was unable to scrounge together enough money to make a dent in the debt.

Last year, Ms. Blaido had a cancer scare and said she couldn’t get an appointment with a doctor at Mercy Hospital. She had to drive more than an hour to get examined at a health system unconnected to Allina.

Allina does not make this policy explicit to patients. It is not mentioned in the health system’s list of “frequently asked questions” about billing practices. In at least one case, Allina has denied that it even existed.

In a lawsuit filed last year in state court in Minnesota, Allina sued a couple, Jordan and JoLynda Anderson, for nearly $10,000 in unpaid medical bills.

In court filings, the couple described how Allina canceled Ms. Anderson’s appointments and told her that she could not book new ones until she had set up three separate payment plans — one with the health system and two with its debt collectors.

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Even after setting up those payment plans, which totaled $580 a month, the canceled appointments were never restored. Allina allows patients to come back only after they have paid the entire debt.

Ms. Anderson recalls being devastated about losing her visit to an endocrinologist that specialized in a chronic condition she has. She had already been waiting four months for the appointment, and was unable to get a new one.

“It felt like I was being punished, and the punishment was you get to stay ill,” she said.

Ms. Bergerson declined to comment on these cases, citing patient privacy.

When the Andersons asked in court for a copy of Allina’s policy of barring patients with unpaid bills, the hospital’s lawyers responded: “Allina does not have a written policy regarding the canceling of services or termination of scheduled and/or physician referral services or appointments for unpaid debts.”

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In fact, Allina’s policy, which was created in 2006, instructs employees on how to do exactly that. Among other things, it tells staff to “cancel any future appointments the patient has scheduled at any clinic.”

It does provide a few ways for patients to continue being seen despite their unpaid bills. One is by getting approved for a loan through the hospital. Another is by filing for bankruptcy.

Susan C. Beachy contributed research.

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Foundation honoring 'Star Trek' creator offers million-dollar prize to develop AI that's 'used for good'

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Foundation honoring 'Star Trek' creator offers million-dollar prize to develop AI that's 'used for good'

To boldly go where no man has gone before.

That’s the mission of the USS Enterprise — and arguably the aim of a $1-million prize being offered through a foundation created to honor the father of the “Star Trek” franchise.

The Roddenberry Foundation — named for Gene Roddenberry — announced Tuesday that this year’s biennial award would focus on artificial intelligence that benefits humanity.

Lior Ipp, chief executive of the foundation, told The Times there’s a growing recognition that AI is becoming more ubiquitous and will affect all aspects of our lives.

“We are trying to … catalyze folks to think about what AI looks like if it’s used for good,” Ipp said, “and what it means to use AI responsibly, ethically and toward solving some of the thorny global challenges that exist in the world.”

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The Roddenberry Prize is open to early-stage ventures — including nonprofits and for-profits — across the globe.

Each cycle, the focal point of the award changes. The spotlight on AI and machine learning arrives as recent strides in the technology have sparked excitement as well as fear.

Concerns abound that AI threatens privacy, intellectual property and jobs, including the work performed by this reporter. Although it can automate busywork, it may also replicate the harmful biases of the people who created it.

California legislators are racing to address anxieties through about 50 AI-related bills, many of which aim to install safeguards around the technology, which lawmakers say could cause societal harm. The proposed legislation targets AI-related fears ranging from data security to racial discrimination.

“We’ve seen with other technologies that we don’t do anything until well after there’s a big problem,” said state Sen. Scott Wiener (D-San Francisco), who wrote a bill that would require companies developing large AI models to do safety testing.

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“Social media had contributed many good things to society … but we know there have been significant downsides to social media, and we did nothing to reduce or to mitigate those harms,” he said. “And now we’re playing catch-up. I prefer not to play catch-up.”

Ipp said the foundation shares the broad concern about AI and sees the award as a means to potentially contribute to creating those guardrails.

The language of the application states that it’s seeking ethical proposals. And much like the multicultural, multi-planetary cast of “Star Trek,” it’s supposed to be inclusive.

“Any use of AI or machine learning must be fair, transparent, respectful of individual rights and privacy, and should explicitly design against bias or discrimination against individuals, communities or groups,” according to the prize website.

Inspiration for the theme was also borne out of the applications the foundation received last time around. Ipp said the prize, which is “issue-agnostic” but focused on early-stage tech, produced compelling uses of AI and machine learning in agriculture, healthcare, biotech and education.

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“So,” he said, “we sort of decided to double down this year on specifically AI and machine learning.”

The most recent winner was Sweden-based Elypta, which Ipp said is using liquid biopsies, such as a blood test, to detect cancer early.

Though the foundation isn’t prioritizing a particular issue, the application states that it is looking for ideas that have the potential to push the needle on one or more of the United Nations’ 17 sustainable development goals, which include eliminating poverty and hunger as well as boosting climate action and protecting life on land and underwater.

“Star Trek,” which first aired in 1966, featured tons of enviable tech, including the universal translator, the tricorder — a handheld device that performed environmental scans, data recording and data analysis — and the transporter, useful for when you need to hop to an alien planet in a pinch.

And you could always trust Capt. Kirk, Mr. Spock and Dr. McCoy to employ the gadgets for good.

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Those who meet the eligibility criteria for the Roddenberry Prize can apply through July 12. The grant will be awarded to one winner in November.

The foundation was launched by Gene Roddenberry’s family after his death in 1991.

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What Americans want from food: Energy, muscle strength, better health and less stress

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What Americans want from food: Energy, muscle strength, better health and less stress

What’s for dinner?

It’s a deceptively simple question, asked millions of times each day. But consider the myriad factors that go into answering it — from cost to convenience to climate change — and it’s no wonder we spend so much time thinking about the food we eat.

And that doesn’t even account for breakfast, lunch or snacks.

Quite a lot rides on Americans’ food choices, including trillions of dollars in spending and our collective risk of developing a slew of chronic diseases. That’s why the International Food Information Council conducts an annual survey on food and health.

“It’s about understanding the mindset of the consumer,” said Kris Sollid, a registered dietitian and senior director of nutrition communications for the industry-funded nonprofit.

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Over nearly two decades of IFIC surveys, taste has consistently ranked as the most important factor in food-buying decisions, followed by price, healthfulness, convenience and environmental sustainability.

In the 2024 survey — which was answered by 3,000 Americans in March — about 30% of respondents said an item’s sustainability mattered a lot when making purchasing decisions about what to eat and drink.

That may seem low, considering that scientists are already scrambling for ways to feed the nearly 10 billion people expected to live on the planet by 2050 while simultaneously reducing heat-trapping greenhouse gas emissions.

But to Sollid, the fact that 30% of those surveyed gave sustainability a score of 4 or 5 on a 5-point scale counts as a strong showing.

“Of course I’d like to see that number higher, there’s no doubt about that,” he said.

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Here’s a look at the state of the American diet, based on data from IFIC’s new findings.

What’s on our minds when we decide what to eat?

For starters, we are looking for something to give us energy or help fight fatigue. But health considerations are top of mind as well.

What kinds of foods are we choosing?

Protein is the most popular nutrient du jour — 20% of those surveyed said they were following a “high protein” diet in the past year, up from just 4% five years earlier. But it’s hardly the only thing we want in our food.

At the same time, Americans are trying to cut back on ingredients that are bad for us.

For instance, 50% of those surveyed said they were trying to limit or avoid sodium, or salt. Too much salt can cause your blood pressure to rise, and high blood pressure (also known as hypertension) is a risk factor for serious health problems like heart disease and stroke.

In addition, 44% of those surveyed said they were trying to limit or avoid saturated fat. This is the type of fat that can cause LDL cholesterol — the bad kind — to build up in your blood vessels, which also increases the risk of heart disease and stroke.

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But Public Enemy No. 1 is sugar.

What’s so bad about sugar?

Our bodies need some sugar for energy. But when we consume too much of it at once — which is easy to do when downing soft drinks, breakfast cereals and all kinds of ultra-processed foods — it gets stored as fat, which can lead to obesity, diabetes and heart disease, among other problems.

Two-thirds of those who took the IFIC survey said they were trying to limit their sugar intake, and 11% said they were trying to avoid it entirely. Their main targets were added sugars in packaged foods and beverages, though some were also cutting back on the natural sugars present in foods like fruits and plain dairy products.

The reasons motivating this retreat from sugar were a combination of current and future health concerns.

What other concerns factor into our food choices?

We’re not just thinking about ourselves when we decide what to eat. For many people, concerns about the way our food is produced matter when they decide whether to buy a particular food or beverage.

That concern extends to animals, to the people involved in all aspects of getting food onto our plates — from farmers to factory workers to grocery store or restaurant staff — and to the planet itself.

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How do we gauge whether a food was made with the environment in mind?

The good news is that this is something more than 70% of survey-takers care about. The bad news is that there’s no easy way to tell.

“There’s no true definition of what makes a food environmentally sustainable,” Sollid said. “There’s not one thing someone can look to on a food package to tell them whether or not this choice is better than that one.”

Instead, eco-conscious consumers use the following clues to guide them:

Will people pay more for an eco-friendly product?

Producing foods and beverages in a sustainable way often means added costs. So IFIC posed this hypothetical scenario:

Imagine you go to the store to buy a specific item and find three options. One costs $3 and has an icon indicating it is “not very eco-friendly.” Another costs $5 and is labeled as “somewhat eco-friendly.” The third costs $7 and is “very eco-friendly.”

Which would you choose?

What’s the relationship between food and stress?

It goes in both directions, the survey found: Stress affects the foods we choose, and the foods we choose can cause stress.

It’s a topic IFIC began asking about following the onset of the COVID-19 pandemic, which created both economic insecurity and food insecurity.

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“COVID uncovered a lot of angst or potential sources of stress that a lot of people had to face,” Sollid said.

Four years in, nearly two-thirds of those surveyed are grappling with a significant amount of stress, up from 60% in 2023.

What are we so stressed about?

Money and health issues remain the biggest sources of stress among those who said they were “very” or “somewhat” stressed. Food choices are weighing on the minds of nearly 1 in 4 people in this category.

Are we eating our feelings?

Some of us are. Nearly two-thirds of people said their mental and emotional well-being had a significant or moderate impact on their diet.

Among those who were at least somewhat stressed, about half said their food and beverage choices suffered as a result. However, a small number responded to stress by seeking out healthier options.

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Peanuts! Get your peanuts! Kids who eat them early are much less likely to develop an allergy, studies conclude

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Peanuts! Get your peanuts! Kids who eat them early are much less likely to develop an allergy, studies conclude

Allergist and immunologist Dr. Gideon Lack’s first inkling that some peanut allergies might be preventable came more than 20 years ago while he was giving a talk in Tel Aviv.

Lack, a professor of pediatric allergies at King’s College London, asked an audience of roughly 200 Israeli allergists how many children with peanut allergies they had treated in the last year. When he asked that question during similar talks in the U.S. and U.K., nearly every hand in the room shot up. To his surprise, only two or three Israeli doctors raised their hands.

He did some research and zeroed in on a key difference: Parents in the U.S. and U.K. were told not to give their infants any peanut products until the age of 3 as a precaution against future peanut allergies. In contrast, puffy peanut snacks were a favorite staple of many Israeli babies’ diets.

Lack and colleagues decided to test the theory that early oral exposure could actually prevent children from developing peanut allergies. After tracking hundreds of children from infancy to early adolescence, they recently concluded that babies who eat the stuff early and often in their first five years of life are 71% less likely to be allergic to peanuts at age 12.

The Learning Early About Peanut Allergy (LEAP) clinical trial ultimately overturned the official guidance given to new parents and has potentially prevented countless new cases of a serious and potentially deadly allergy.

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“It was revolutionary,” said Dr. Rita Kachru, a UCLA allergist and immunologist. “It really completely shifted the paradigm and the understanding of food allergy.”

The team recently published the third and final report of their longitudinal study.

In the first phase, whose results were published in 2015, the team recruited 640 babies between the ages of 4 and 11 months deemed at high risk for developing allergies, either because they were already allergic to eggs or had severe eczema.

Half the babies were prohibited from consuming any peanut product in their first five years. The other half had to eat at least 6 grams of peanut protein per week.

At the five-year mark, 13.7% of peanut-avoiding kids who had no sensitivity to peanuts at the start of the trial had peanut allergies by the end.

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But only 1.9% of the peanut-eaters in this group did — an 86% relative reduction in peanut allergy risk. For kids who showed some initial sensitivity to peanuts at the start of the test, eating peanuts was associated with a 70% relative reduction in developing a full-blown allergy.

“The results have the potential to transform how we approach food allergy prevention,” Dr. Anthony Fauci said at the time. Fauci was then director of the National Institute of Allergy and Infectious Diseases, which helped fund the study.

In the second phase, the researchers asked 556 participants from the original study to avoid peanuts entirely for a year, to see if continuous peanut exposure was necessary to prevent allergies from forming. Only a few kids who had previously eaten peanuts without issue developed an allergy after going without them for 12 months.

In the third phase, published last month in the New England Journal of Medicine, the researchers tested 508 children who had participated in the first two studies.

Participants had been free to eat or avoid peanuts as they wished in the six years since they were last studied. The team found that 15.4% of participants from the group that avoided peanuts in early childhood had peanut allergies at age 12, while only 4.4% of those who ate peanuts early on did.

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“It was doubly gratifying because our hypothesis was correct, but more importantly, we now have a strategy to prevent — and I would argue, nearly eradicate — the development of peanut allergy in the population,” Lack said over Zoom from London.

Incidence of food allergies began rising sharply in the 1980s, particularly in industrialized Western nations. In 1997, 0.4% of people in the U.S. had diagnosed peanut allergies. Today, about 1.8% do.

Amid the search for explanations, one 1989 study found that infants whose exposure to common allergenic foods was severely restricted in their first two years of life ended up with fewer allergies than those in a control group.

Largely based on that research, in 1998 the U.K. instructed women to not eat peanuts during pregnancy or while breastfeeding if they or their partner had a family history of allergies, and to prevent their child from eating peanuts until the age of 3. The American Academy of Pediatrics adopted similar guidelines in 2000.

After the first two LEAP reports came out, both the American Academy of Pediatrics and British Society for Allergy and Clinical Immunology issued new guidelines in 2017 incorporating the results. They now advise children at greater risk of developing a food allergy — those with eczema, egg allergies or both — to start eating peanut products between 4 and 6 months. For children without risk factors, the AAP says, peanuts can be introduced whenever the baby starts eating solid foods.

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“Previous guidance and recommendations prior to the LEAP study, where we were just avoiding peanuts because we were afraid of peanut allergy, was completely thrown out the window,” said Dr. Jenny Lee, a UC Irvine allergist and immunologist. “It changed the way that we practice.”

Nine years after the initial findings were published, there are signs that the approach is preventing new allergy diagnoses. In Australia, where guidelines also now encourage early peanut consumption, a large study published in 2022 found that 2.6% of 1-year-olds were allergic to peanuts in 2018-2019, compared with 3.1% in 2007-2011.

Despite the strong evidence, the updated AAP guidelines haven’t translated into clear communications to all parents that early peanut introduction prevents allergies, said Dr. Katie Marks-Cogan, an allergist and immunologist who practices in Culver City.

Marks-Cogan says she asks parents of children with newly diagnosed food allergies if their pediatrician talked to them about early introduction of allergenic foods. Most of the time, they say no.

“They will still say … ‘Aren’t you supposed to wait until a year for milk, and three years for tree nuts and peanuts?’ So a lot of parents still think that, and it’s because it’s slow to change things in medicine,” Marks-Cogan said. “Introducing early is actually safer and it’s better.”

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Times staff writer Karen Kaplan contributed to this report.

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