Wednesday, May 25, 2022

Patient Care vs. the Economics of Emergency Medicine

I am interested in in the hospital bills because i think that there's such a mess such a mess and there's nobody really interested in fixing it either uh so let me give you some examples there was a woman by the name of sarah cliff k-l-i-f-f i have been uh tracking her uh .

For a couple of years she wrote for a publication called vox and her style was to focus on er bills and try to understand why they were what they were and to expose the soft underbelly of finances and from the emergency medicine point of view well anyway .

I think one of her last stories for vox was a story that basically indicated that san francisco general hospital which is the only trauma center in san francisco so everybody goes there is out of network to every insurance company out they they took nobody's insurance none zero .

In terms of a negotiated rate so what happened is is that people who have relatively minor injuries basically they trigger the the button that says trauma center activation which which opens the cash register and twenty thousand dollars pours in and .

So they basically in their insurance companies of of the patients in the trauma center would pay what they thought was fair and uh and then the patient would get the rest of the bill well what they thought was fair they would pay six .

Eight thousand dollars for you know a really kind of nothing visit and then uh the patients were left with the with the rest and these were big numbers uh so here we have insured patients who basically come away with huge bills from this trauma center so that ended basically because the .

Board of supervisors in in san francisco got wind of this they shut it down they said we cannot do that anymore i don't know why it took anybody so long to find this out but anyway that was sarah kliff's claim to fame a couple years ago uh i found out that she were now rights for .

The new york times and uh she did a paper an article august 22nd 2021 that looked at the variability that occurs when hospitals negotiate with insurance companies what they're going to accept or pay each other .

And the fact that it is extraordinarily inconsistent one carrier to the other and that if you let one carrier see what you've contracted with another they're going to say hey you're eight for this is better i want that rate so it's really kind of hush-hush kind of thing .

These numbers in her research uh she created there are some examples here let me just get here so a pregnancy test the cash price of her pregnancy test was ten dollars the price to blue cross ppo patients in new jersey for a pregnancy test the agreed .

Upon price is 93 dollars nine fold so we're not talking about you know 50 more 25 it's nine fold mri costs at aurora st luke's hospital in milwaukee a thousand ninety three dollars if you had a united hmo plan united hmo versus four thousand twenty nine dollars for the united ppo same insurance hmo .

Ppo 1000 versus 4 000 like how i need somebody to help me with this i don't understand it you know if you got a thousand dollar um colonoscopy i would be a little concerned because maybe it's only going to be eight or nine inches you know i think there's a general rule that you .

Get what you pay for so if you want to go all the way around it's gonna be four thousand bucks uh knee mri at baptist memorial in memphis uh knee mri 210 bucks one insurance company is getting it for 200 another is paying 2 800 massachusetts general hospital a knee .

Mri starts out at eight thirty eight hundred thirty dollars four times more than the baptist memorial hospital you could take a jet private jet to fly down the baptist and get your thing done and have change left over here's here's one erlanger health in tennessee flu shot 54 versus 201 dollars for the same same same shot .

Um there are lots and lots of examples this is just a this is just a quagmire her job is to show the the underbelly of the of the medical quote-unquote system that we have and you can you imagine trying to fix this it's not going to happen it's not going .

To happen one of the things that has made this kind of apparent is the requirement that hospitals have their charge master available for normal people so that's they don't like that at all because showing the charge master shows what what what you've negotiated with at various insurance companies so when one sees the other .

That said hey we want a better deal than you gave us so the charge master thing is an issue most of the hospitals i think are just not doing it there there's very little consequence negative if they don't and so they're just dragging their feet uh on on this .

Uh there's a lot of a lot of interesting stuff to be seen in in their charge masters you know fortunately these bills really don't matter to me because i have a thing called socialized medicine medicare i have a supplement it works great i .

Don't think i paid any money except what comes from the medicare and the supplement for years and years i think i don't i think the problem with medicare is it just pays bills there's no really good effort to kind of narrow variability et cetera evidence-based medicine is that they just pay bills .

So this gets me back to the concept that medicare and medicaid do not cover the cost of admitting their patients at a hospital all the administrators say you know we can't live on medicare or medicaid kind of thing i you would think that they could .

Because the government must have set the rates in some ways so that they could live on it but they say no so what happens then is private insurance companies pay a multiple of what medicare would ask and that must be the money to help the hospital deal with the lack of funds .

For medicare and medicaid so private insurance companies because of the rates that they're paying hospitals are floating medicare and medicaid and i don't think you know that doesn't sound right i mean this these are private companies it's not their job to cover for the .

Lack of payment for medicare or medicaid but anyway that's one of the issues that comes up so um i need somebody to tell me that's not true that private insurance companies are not underwriting medicare or medicaid because everything i see says they are you know the other thing is is that .

When you go to hospital there's a whole bunch of things to sign nobody reads anything um but i got the sense of the power of your signature because if i just write something on a piece of paper or a computer or uh form .

I can order a five thousand dollar test on somebody uh or an expensive thrombolytic or something like that and this little signature gives me the right to do that in the setting of my license at the practice medicine in california and .

All the time that we're doing that we're trying to help the patient and do the best we can for them but as soon as you put that signature down out comes the quagmire of all of the prices and all the all of the discrepancies and all of the unfairnesses and here's an issue that .

Bothers me a lot of these bills that get sent out are going to be bills that patients have to pay their own way thousands of dollars so you try to help them out but look they're they're suffering because this bill is just not reasonable or they have no way to pay it .

So i feel kind of bad about that because we know that there's a lot of people who are getting hospital bills that they just cannot afford to pay and we triggered it all not .

We don't want to harm anybody but we trigger it all but it's not my fault but i would like to do something and i can't do a damn thing to affect affect hospital bills or or this ridiculous insurance system that we have we can't do a thing about it except try to do as best as i can on the clinical side .

All right that's it uh send me an email if you want to be happy to re correspond with you wr bukata thanks for listening and bye for now


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