Josh Parker is an operations project coordinator in Milford.

It’s no secret that healthcare costs have skyrocketed in recent years. According to some estimates, Americans now owe at least $220 billion in medical debt. And yet, rates of chronic disease have increased steadily in the last two decades. So, why are Americans paying so much for medical care yet getting sicker? Part of the problem is the shadowy cadre of consultants and middlemen who increase costs for patients.

In fact, a whole industry exists to extract maximum profit from patients and their insurance companies on behalf of hospital chains. Here’s one that you’ve probably never heard of: “revenue cycle management companies”— an innocuous sounding name for medical industry tacticians making healthcare more expensive in the Granite State.

New Hampshire has seen several high-profile hospital consolidations in recent years. You’ve probably read the recent headlines about the controversy surrounding Beth Israel Lahey Health’s acquisition of Exeter Hospital. As hospital chains grow larger, they attain outsized power in the marketplace, and they don’t hesitate to throw their weight around. To help them wield this power effectively, they hire consultants called revenue cycle management companies who show them ways to exploit billing loopholes and engage in high-pressure negotiating tactics.

Dishonest billing practices help hospitals make vastly more money for services that otherwise would cost much less. Following the advice of revenue cycle management companies, hospitals frequently reclassify the doctor’s offices they own as hospital settings, thereby driving up healthcare costs without making any improvements to the quality of care. This leads to insurers paying more and, consequently, to insurance premiums going up.

Revenue cycle management companies also help hospitals apply maximum pressure on insurers during contract negotiations. One of the most abusive tactics is the “out-of-network” strategy, where hospitals threaten to exit an insurer’s network if they don’t agree to higher payments. The hospitals know that the insurer’s customers will panic when facing out-of-network rates at their local hospital, and this puts maximum pressure on insurers to acquiesce.

In Nashua, St. Joseph’s Hospital has been employing these abusive tactics. Over a decade ago, the hospital was bought out by Covenant Health, which owns hospitals in six states. It shocks the conscience that a Catholic hospital which enjoys tax-exempt status as a “non-profit” should be willing to put big profits ahead of patients’ access to care. But they are, and what’s worse, it’s working: St. Joseph’s charges insurers three times what Medicare is willing to reimburse for the exact same service, helping them rake in seven-figure profits.

Their ministry, it seems, is not on behalf of patients, but rather, the Almighty Dollar.

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Thankfully, there have been some efforts to push back against hospitals who employ these strategies. Sen. Maggie Hassan recently sponsored bipartisan legislation to put an end to hospitals’ dishonest billing practices. But there is more to be done if we hope to see medical costs become affordable.

In the meantime, I hope you’ll join me in calling on New Hampshire hospitals, especially those that claim tax-exempt, non-profit status, to prioritize patients’ healthcare access over outsized profits.