Another painful NYT article

[JoeyB]

I usually put these articles into the framework of "I'm still angry at my (doctor) mommy and daddy" in terms of the reporter.

However this situation highlighted seems particularly troubling and dishonest...

http://mobile.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0

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[ram006]

1800 for a gallbladder... lol.

 

[Pir8DeacDoc]

some of that may be necessary but let's not act like this isn't shady and dishonest.

 

[Mad Jack]

$118,000 is pretty unreasonable by any measure. There's some pretty unethical billing practices out there, it's a fact that is pretty difficult to deny. Patients should have a right to at least know if they will be charged by out of network providers, how much those providers charge, and if they are necessary. Neurosurgeons charging $25,000 an hour that refuse to negotiate with patients and pursue legal action against them are not doing the medical profession any favors. They make it very easy for politicians to say, "see? These physicians don't care about you, all they want is money, and they'll bleed you dry if you don't pay up. You need to have us, the government, to step in and control them." Bad actors make bad policy an increasingly likely reality.

 

[deleted480308]

$118,000 is pretty unreasonable by any measure. There's some pretty unethical billing practices out there, it's a fact that is pretty difficult to deny. Patients should have a right to at least know if they will be charged by out of network providers, how much those providers charge, and if they are necessary. Neurosurgeons charging $25,000 an hour that refuse to negotiate with patients and pursue legal action against them are not doing the medical profession any favors. They make it very easy for politicians to say, "see? These physicians don't care about you, all they want is money, and they'll bleed you dry if you don't pay up. You need to have us, the government, to step in and control them." Bad actors make bad policy an increasingly likely reality.

I agree with you 100% about announcing charges ahead of time. I don't remotely think physicians have a responsibility to negotiate prices just because someone can't/won't pay (assuming they announce up front the price)

 

[Mad Jack]

I agree with you 100% about announcing charges ahead of time. I don't remotely think physicians have a responsibility to negotiate prices just because someone can't/won't pay (assuming they announce up front the price)

I agree. If the man agreed to pay the surgeon that amount up front it is one thing, but charging unreasonably high fees when the patient likely could have waited a couple hours for a resident or in-network physician to be available had they known the cost difference is pretty damn absurd.

 

[deleted480308]

I agree. If the man agreed to pay the surgeon that amount up front it is one thing, but charging unreasonably high fees when the patient likely could have waited a couple hours for a resident or in-network physician to be available had they known the cost difference is pretty damn absurd.

it's another problem with out stupid system that expects our insurance to pay for everything...most of us don't even think to ask what something costs

 

[Vandalia]

The theory of contracts that has been dominant in the United States over the last 100 years has held that a necessary element to have a contract is "meeting of the minds." This means that each party knows exactly what their rights and obligations are.

Do not be surprised if courts start to rule that many patient-physician/hospital contracts are invalid. Or, in other words, that patients have no obligation to pay for services that were not specifically described with an exact price before treatment takes place.

 

[Mad Jack]

it's another problem with out stupid system that expects our insurance to pay for everything...most of us don't even think to ask what something costs

The worst part of it was that this guy did ask. He went out of his way to inquire about the costs if care and still got blindsided. The healthcare marketplace is lacking in both accountability (both personal and business, as there is such a disconnect between the patient and providers) and transparency (on every front). Unfortunately no reasonable solution to the problem is politically tenable for a multitude of reasons.

 

[deleted480308]

There are a ton of problems with accountability, understanding, and transparency.

One of the problems at this hospital, like many, is that they have a lot of different providers from differing private groups. One of my friends who has a kid with a serious congenital heart issue had a similar problem - they would be at an in-network hospital, but several of the consultants during their kid's hospitalizations will be out of network - they just happened to be the on-call group the day the consult was needed.

My issue with the article is that it takes the strong stance of not just blaming physicians for all of this, but coming darn close to outright stating that they do it deliberately as a money grab.

I think the big problem/failing of most physicians is their lack of awareness of the costs/charges involved in different aspects of care.

and if the physician poked their head in the room and led with, "what insurance do you have, we need to make sure you can afford me"......the world would implode

 

[Vandalia]

and if the physician poked their head in the room and led with, "what insurance do you have, we need to make sure you can afford me"......the world would implode

This is the reason why many people are beginning to support the idea of the government setting prices. That is also why it is in out best interest to head off that trend.

I like to make an analogy to buying a ticket for a professional sporting event (MLB, NBA, NFL.) I would not/have not had a problem with paying $200 for a ticket. That really doesn't bother me since I really don't have any reference for what a ticket is worth. However, it drives me crazy when I end up paying $10 for a cup of soft drink. That is because I KNOW what that actually costs.

The same thing applies with medicine, and you can sort of see it in this article. This patient did not have a problem paying his physician roughly $6,000 for the procedure. However, with that as a reference, he balked at paying an "assistant" 15-20x that much. A patient may not complain with getting a bill from an ED physician for $500 for level 5 care. But she will complain loudly for the proverbial $10 tylenol.

We talk about "jackpot justice" when it comes to malpractice, but we also have "jackpot" healthcare for physicians. I can spend an hour in critical care and might make $5. Then I can have a quick procedure in a patient with great insurance and make close to that amount in 10 seconds. It balances out (sort of) for the health care provider, but the patient can end up feeling the big loser.

As patients become more knowledgeable, they are paying close attention to the bills. Here is an example from one of my relatives:

She had a lap chole. During the procedure, the surgeon got stuck in the hand with a needle. He called in his partner and went to the ED for treatment. When the EOB came, she found that she was billed for both surgeons. Her response was pretty reasonable - "They screw up and my insurance ends up paying almost twice as much !?!"

Now, I have no idea how to fix that problem. I know some are making changes to how they interact with patients. Many inpatients have complained about how they are billed $75 for a hospitalist who just sticks his head in the door and says "hi." I know they are starting to spend an extra 30 seconds and say "I just looked over your chart, saw the films they took this morning, checked your labs, and talked with the consultant." It seems to have worked and patients seem to be a little more aware that there is a lot more to inpatient care than just talking with the patient.

I think sometimes we spend too much time looking for the magical solution that will fix everything, and ignore the trivial things that can often make a difference.

 

[deleted480308]

This is the reason why many people are beginning to support the idea of the government setting prices. That is also why it is in out best interest to head off that trend.

I like to make an analogy to buying a ticket for a professional sporting event (MLB, NBA, NFL.) I would not/have not had a problem with paying $200 for a ticket. That really doesn't bother me since I really don't have any reference for what a ticket is worth. However, it drives me crazy when I end up paying $10 for a cup of soft drink. That is because I KNOW what that actually costs.

The same thing applies with medicine, and you can sort of see it in this article. This patient did not have a problem paying his physician roughly $6,000 for the procedure. However, with that as a reference, he balked at paying an "assistant" 15-20x that much. A patient may not complain with getting a bill from an ED physician for $500 for level 5 care. But she will complain loudly for the proverbial $10 tylenol.

We talk about "jackpot justice" when it comes to malpractice, but we also have "jackpot" healthcare for physicians. I can spend an hour in critical care and might make $5. Then I can have a quick procedure in a patient with great insurance and make close to that amount in 10 seconds. It balances out (sort of) for the health care provider, but the patient can end up feeling the big loser.

As patients become more knowledgeable, they are paying close attention to the bills. Here is an example from one of my relatives:

She had a lap chole. During the procedure, the surgeon got stuck in the hand with a needle. He called in his partner and went to the ED for treatment. When the EOB came, she found that she was billed for both surgeons. Her response was pretty reasonable - "They screw up and my insurance ends up paying almost twice as much !?!"

Now, I have no idea how to fix that problem. I know some are making changes to how they interact with patients. Many inpatients have complained about how they are billed $75 for a hospitalist who just sticks his head in the door and says "hi." I know they are starting to spend an extra 30 seconds and say "I just looked over your chart, saw the films they took this morning, checked your labs, and talked with the consultant." It seems to have worked and patients seem to be a little more aware that there is a lot more to inpatient care than just talking with the patient.

I like the ok surgery center model.....all inclusive fixed up front prices

 

[Pir8DeacDoc]

There are a ton of problems with accountability, understanding, and transparency.

One of the problems at this hospital, like many, is that they have a lot of different providers from differing private groups. One of my friends who has a kid with a serious congenital heart issue had a similar problem - they would be at an in-network hospital, but several of the consultants during their kid's hospitalizations will be out of network - they just happened to be the on-call group the day the consult was needed.

My issue with the article is that it takes the strong stance of not just blaming physicians for all of this, but coming darn close to outright stating that they do it deliberately as a money grab.

I think the big problem/failing of most physicians is their lack of awareness of the costs/charges involved in different aspects of care.

Don't be so naive. Do you think some physicians don't do this as a money grab? I'll call you in for mine and you call me in for yours? We'll both stay in and out of different networks. I mean the guy did what I presume is a straightforward operation and was going to bring in 100k for being an assistant surgeon? Give me a break. That's complete BS.

I'm not saying I've seen outright fraud but there are people, both physician and administrator, that bend things as much as possible.

 

[Pir8DeacDoc]

If this neurosurgeon does this five times a year he makes more money than most any other speciality before even lifting a finger the rest of the year. I agree with you that most physicians are honest. But in theory this is just bad luck for the patient. Not illegal, just potentially unethical. Regrettably money makes good people do bad things.

 

[vhawk]

This is the reason why many people are beginning to support the idea of the government setting prices. That is also why it is in out best interest to head off that trend.

I like to make an analogy to buying a ticket for a professional sporting event (MLB, NBA, NFL.) I would not/have not had a problem with paying $200 for a ticket. That really doesn't bother me since I really don't have any reference for what a ticket is worth. However, it drives me crazy when I end up paying $10 for a cup of soft drink. That is because I KNOW what that actually costs.

I think what you mean is that you mistakenly believe there is such a thing as "what that actually costs" and you are rarely disabused of this belief because soda often costs about the same regardless of where you go.

The same is true of healthcare.

 

[vhawk]

The debate of who pays for a mistake is a very interesting one.
.

Agree. I'm sure it is an unpopular belief, but I think except in cases of actual negligence and malpractice, it is 100% on the patient. They are the one who chose to undergo the procedure. As long as the risks were disclosed (regardless of whether the patient took them seriously or not) then complications and mistakes are part of the cost of doing business, and are a sequela of the decision to undergo a procedure.

The reason this seems so insane is because patients are sort of conditioned, by various factors, into believing that healthcare is "something that happens to them" rather than something they actively choose and cause to happen.

 

[Vandalia]

I think what you mean is that you mistakenly believe there is such a thing as "what that actually costs" and you are rarely disabused of this belief because soda often costs about the same regardless of where you go.

The same is true of healthcare.

There is a very defined cost for everything.

I can guarantee you that your hospital administration can tell you exactly what their cost is for every procedure or DRG, and precisely what their margin is for those items.

 

[deleted480308]

There is a very defined cost for everything.

I can guarantee you that your hospital administration can tell you exactly what their cost is for every procedure or DRG, and precisely what their margin is for those items.

the point that you are either missing or choosing to ignore is that cost to the provider is completely irrelevant to cost to the consumer.....it's none of my business what my providers costs are, the only thing that matters is that my provider honestly tells me what they are going to do and how much it will cost me. (surprises like random assistant surgeons popping in are different case)

To imply that I have a right to be angry if my provider tries for a profit margin over "x" is illogical. I don't get to know their profit margin because their costs are none of my business.

 

[Slack3r]

I read this article this morning.

Honestly the only reason I kept reading until the end was that I figured somewhere, at some point, the author was going to discuss the possibility that some consults and intraoperative assistants are actually medically needed. But it never happened.

NYT should be ashamed. This is the worst fear-mongering, conspiracy theory driven article I think I've ever read from them.

Pretty sure they lost the capacity to feel shame a long time ago.

 

[vhawk]

There is a very defined cost for everything.

I can guarantee you that your hospital administration can tell you exactly what their cost is for every procedure or DRG, and precisely what their margin is for those items.

There is a current cost for lets say a 5mm laparoscopic scope. Tomorrow I go and destroy 99% of the laparoscopic scopes in the US. Now what is the cost of your lap scope?

I dont think you understand what prices are. Its ok, most people dont.

 

[vhawk]

the point that you are either missing or choosing to ignore is that cost to the provider is completely irrelevant to cost to the consumer.....it's none of my business what my providers costs are, the only thing that matters is that my provider honestly tells me what they are going to do and how much it will cost me. (surprises like random assistant surgeons popping in are different case)

To imply that I have a right to be angry if my provider tries for a profit margin over "x" is illogical. I don't get to know their profit margin because their costs are none of my business.

And there is no "correct" profit margin either (though I guess in some sense you could argue that the correct profit margin is 0 or 'equal to opportunity cost' or something like). People claiming that there is a correct profit margin = sour grapes.

 

[DoctwoB]

And there is no "correct" profit margin either (though I guess in some sense you could argue that the correct profit margin is 0 or 'equal to opportunity cost' or something like). People claiming that there is a correct profit margin = sour grapes.

Not necessarily. It's reasonable to be upset that the healthcare market is so ridiculously distorted that this kind of behavior can occur. It's reasonable for hospitals and physicians to bill to maximize their profits. It's not reasonable that our system is so opaque and inaccessible that patient's can't make price sensitive decisions.

 

[Vandalia]

There is a current cost for lets say a 5mm laparoscopic scope. Tomorrow I go and destroy 99% of the laparoscopic scopes in the US. Now what is the cost of your lap scope?

I dont think you understand what prices are. Its ok, most people dont.

Your example is not correct. Market price has no relation to cost.

If you buy a scope for $10K, and then every other scope in the world is destroyed, the scope still costs $10K. Or more commonly, if I bought a smuggled Apple Watch for $100K one month ago, and now its selling price is $10K, my cost is still $100K.

If a buy a share of XYZ Supercomputing for $10/share, and they discover a cure for cancer and the price jumps to $1000/share, that doesn't change my cost basis one iota. The cost of the share was still $10.