A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I'm a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab work?
The attending was in her room for less than two minutes and never examined her. But the CT scan and blood work were ordered. My friend received intravenous fluids (about $1 worth), pain meds (about $5 worth of dilaudid), and a $10,000 bill from the hospital. To add insult to injury, the bill from the ER attending was for service at the highest billable level.
My friend had the good sense and gumption to call the ER group's practice manager to point out that billing at that level was fraudulent. The ER group had the good sense to reduce the bill by half.
Shortly after that, I received a call from a patient on whom I had performed an upper endoscopy to remove a small gastric polyp. Because removing stomach polyps can be complicated by bleeding, I did the procedure in the hospital rather than an outpatient center. The whole thing took 15 minutes. Anesthesia wasn't required, just routine conscious sedation. So, my patient wanted to know, what had I done that warranted an $18,000 bill from the hospital?
I had absolutely no explanation. For $18,000, you can just about buy your own endoscope. Amortized costs for an upper endoscopy at this hospital, including the use of the endoscopy unit, salaries for the whole staff, medication and equipment expenses is probably not more than $200 for 15 minutes. By the way, the doctor doing the procedure — in that case, me — typically gets about $175 for an upper endoscopy.
And then there are the costly procedures you could probably do without.
Recently, a surgical group owned by the same hospital hired a surgeon with an interest in esophageal disorders, particularly surgery for acid reflux — heartburn. He's a good guy and capable. So the hospital decided to create a “center of excellence” for esophageal diseases. A hurdle quickly became apparent. My town isn't flush with esophageal experts. The hospital has excellent generalists who could contribute, but just one specialist surgeon who was retiring (hence the new hire). Still, the Joint Commission, an independent healthcare accreditation outfit, would certify the hospital's new center if certain standards were met and a fee was paid. That's not exactly the same as excellence.
A marketing plan was developed to get the word out. But really, far fewer than 1% of frequent heartburn sufferers will benefit from surgery. Most people with heartburn would be best served by getting help modifying their lifestyle. That's particularly true because the behaviors associated with reflux (overeating, obesity, alcohol consumption and smoking, to name a few) are also risk factors for heart disease, diabetes and a variety of cancers.
However, lifestyle modifications are not profitable and surgery is very profitable. The surgeon (and his colleagues who agreed to work with the center) doesn't want to perform surgery that's inappropriate or not indicated. He's not like that. But he's employed by the hospital. You can see where this is going. The center is up and running.
The American healthcare system is capable of many wonderful things, but not all of them are about health or care. It is just as often about selling you things you probably don't need at a ridiculous price, or finding ways to charge you a ridiculous price even for what you do need.
The folks driving it aren't generally physicians, nurses or other “healthcare providers” (to use the parlance of the times). They are businesspeople — executives that run hospitals, pharmaceutical concerns and insurance companies — using healthcare as their instrument to make money. And sadly, the average physician doesn't have a lot of choice about lashing his raft to these organizations if he wants to practice his trade.
As a nation, we spend far more than other developed countries for healthcare, and our outcomes are not as good. Those other countries generally have some form of a single-payer system. Here, we're told single-payer horror stories: People are dying in Canada and England waiting for care.
I've got news from the front lines of the U.S. system. People are dying here, too, in large numbers, and at the same time they're going broke paying the bills. Medical expenses, even now that many more people have some form of insurance, are a prime cause of bankruptcy and financial insecurity in the U.S.
No healthcare system is perfect, but here's what the rest of the civilized world understands: Healthcare is a right. There is no place for rampant capitalism in treating the sick. This advice is harsh but true: When it comes to your healthcare, buyer beware.
Michael Jones is in private practice on the Eastern seaboard.