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PDF versionHospitals, Alice's Wonderland, and the bishops on health care
by Bill Tammeus on Apr. 20, 2011
Hospitals file Medicare and insurance claims using national claim format standards. The standards state that total charges are submitted. Medicare uses the information on the claim to determine how much to pay. Other payers do the same. Many managed care payers are contracted with the hospital and pay according to the contract terms. Using the national standards for claims format allows for electronic claims submission and supports each payer’s informational needs to pay the claim based on regulations or contracts. Saint Luke’s works with uninsured patients to assist them in applying for government programs like Medicaid whenever possible. The hospital also works with uninsured patients individually to offer financial assistance for those who qualify and to set up payment plans for any patient.
The Web site of the U.S. Conference of Catholic Bishops devotes lots of attention to health care. As it should.
But my own recent personal experience with our health care system makes me think the bishops -- and all American religious leaders -- might do well first to insist that the system be built on rigorous honesty instead of relying on the incomprehensible money games that now seem to characterize it -- games a friend who serves as CEO of a major health care non-profit agency tells me are “absurd.”
It’s fine for the bishops to say this: “The USCCB has consistently worked for access to affordable health care for all that reflects these principles: Respect for Life; Priority Concern for the Poor; Universal Access; Comprehensive Benefits; Pluralism; Quality; Cost Control; and Equitable Financing.”
But to that list I would add a system of cost accountability not shrouded in so much mystery that patients are left baffled and unable even to begin to know how to make wise choices.
That pricing accountability is exactly what was missing when I had sinus surgery in early January. My primary insurance is through Medicare. In addition, I have a Medigap policy through Blue Cross/Blue Shield.
Before my outpatient surgery I made a wild guess that this surgical clearing-out procedure might cost my two insurance companies up to $6,000. (I purposefully inflated my guess to be on the safe side.)
Thus, you can imagine my astonishment when I received notice that St. Luke’s Hospital of Kansas City (an excellent facility with Episcopal roots) had billed Medicare $38,966.82.
Later, I received word that my surgeon had billed Medicare for an additional $16,265. Three other health care workers somehow involved in my procedure separately billed Medicare for a total of $2,206. Follow-up care added to the total bill, which eventually topped $60,000. (Should I have my $60,000 nose insured?)
In the end, Medicare paid the hospital just under $7,500 and my supplementary plan paid it just less than $2,000. I paid nothing. Then Medicare paid the surgeon $1,599.40 of the $16,000-plus bill he submitted while my Blue Cross/Blue Shield plan paid him just under $400. Again, I paid zero.
“This is normal, absolutely normal,” a retired top Medicare executive told me when I sought someone to explain why this ballooned-up billing system seems so dishonest.
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Still, he acknowledged that “why hospitals have this cost structure set up I have no idea. These are made-up figures” that have little to do with the way Medicare figures reimbursements rates based on “Diagnosis Related Groups (DRG)” and other factors.
So I asked the hospital to explain things, and here’s its full, official response:
So these “national claim format standards” result in “total charges (that) are submitted.” Got that? Me, neither.
I’m glad health care reform passed Congress last year, though I agree that it needs to be improved. But in the end we cannot have a reliable, trustworthy system rooted in integrity if its billing system comes from Alice’s Wonderland.
And if religious groups such as the U.S. bishops don’t argue the case for fundamental honesty in our health care system, who will?
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I don't understand Catholic
I don't understand Catholic Health Care
In this day, why sectarian healt providers are necessary is unclear to me. What exactly distinguishes a "Catholic" hospital? Is the services (contraception) that it does not offer? Is that a reason for existence?
With most of the cost carried by insurance and ogvernment programs and in an era of cost management by those organizations, is there really any significant charitable contribution by the Catholic Church? In an era where emergency rooms become the default GP office for many uninsured, does being Catholic hospital really provide any greater margin of charity to those in need?
On the other hand, it places the bishops in a position of lobbying for their own self interest, the promotion of health care funding that finances the organizations under their control.
"On the other hand, it places
"On the other hand, it places the bishops in a position of lobbying for their own self interest, the promotion of health care funding that finances the organizations under their control."
The Daughters of Charity or other orders control the vast majority of Catholic healthcare services - NOT the Bishops. Time to get on the nuns' backs if you are serious about this. Oh, never mind, this is NCR - it can't be nuns who are culpable of any thing. It must be the Bishops!
I would agree. If one is
I would agree. If one is uninsured, the experience is like haggling at a swap meet. Why every patient could pay different for the exact same thing seems fraudulent.
I've seen this craziness with
I've seen this craziness with our health care, too, and we are not on Medicare. Weird.
The medical care billing
The medical care billing system is total insanity. Everyone gets bills like this, even when you are not on Medicare. A $1,000 bill will go to a health insurance company and come back as paid for $100 in network. What is happening? I have no clue.
No one can help detect fraud because the system is so dishonest from top to bottom. In most cases now, a patient cannot even get a bill for medical services before leaving the doctor's office if the patient has insurance. If the patient does not have insurance, it is cash up front or no medical care.
Everyone knows the system is crazy but you don't find the Tea Party or Republican or even many Democrats fighting for real reform.
These kinds of billing games
These kinds of billing games contributed to my decision to retire early from medical practice.
The hospital knows in advance what it will be paid by medicare Based on the "DRG" mentioned above. But it cannot bill for this amount lest other third party payors decide this is the standard fee. Payments from private medical insurance companies depend on individual contracts between the hospital and these insurance entities, and may not be at all related to the actual bill. In addition, hospitals tend to over-bill those who can pay to compensate for uncollectable amounts due from emergency patients whom they cannot refuse to care for, but who have no means to pay.
If you have no insurance but are employed or have assets, hospitals will attempt to collect the full amount of their inflated bills. In the example above, they would attempt to collect the full $38,966.82 for a hospitalization they know they could collect only $9500 for if the patient had medicare plus a supplement.
Physicians over bill for similar reasons.
Richard A Grant M.D.
"I’m glad health care reform
"I’m glad health care reform passed Congress last year".....?????
It is obvious that YOU didn't read the health care act! Prepare yourself. EVERY CATHOLIC HOSPITAL AND HEALTH CARE FACILITY WILL BE CLOSED....AS WILL ALL CATHOLIC EDUCATION FACILITIES FROM PRE-k TO UNIVERSITY.... It is all in the health care act.
The health care act is pure deception. It is designed for the complete collapse of the entire health care system and to establish the infrastructure for a new government run/owned/operated health care program. It is about control, indoctrination, eugenics, medical and social research.
Health care reform needs/needed to happen...but not with this act. Read the act. It took me three days...(72 hours). READ THE ACT!
p.s. Through this act, children no longer belong to their parents...they now belong to the state...READ THE ACT.
You are a moron.
You are a moron.
Thanks Paul. Is it true that
Thanks Paul. Is it true that Alinsky and Soros advise ingnoring the issues and always tell you to start by using the ad hominem arguement? It seems efficient and lets you think you are engaged without really having to think at all.
I will be honest with you. I
I will be honest with you. I really wish I hadn't read the health care act! I am an RN and have worked as an RN for over twenty years. My first degree was in anthropology and I worked many years as an environmental activist. I believe in preservation of the planet and our precious world given to us as a gift by our creator. I won't go into it now, but the whole "green movement" has indeed been co-opted by the "green dragon" movement. With regard to the health care act I do encourage you to read it before calling me a moron. The entire act is designed for the collapse of the entire health care system. Yes, health care needs to be overhauled. I have had many patients over the years experience nightmare experiences with the current system. But this bill is not about improvement. It is about collapse. I think one of the things that really surprised me about this bill was just exactly how much of the groundwork had been laid in previous act prior to this one. With just a change or a deletion of a word here and there in previous laws it succeeds in completely changing the entire meaning of those previous laws. With respect to children, it was last summer that I realized that the act is really all about the children. There are entire sections in the act that deal with the "adult formation of children". After having read the bill (now law) I was shocked to discover what is actually contained within this legislation. This Act is not about empowering patients to take charge of their own health care, improving the quality of health care, nor about controlling health care costs, nor offering “hope” about the need for more doctors. This Act will destroy our health care system.
This law steals from parents the responsibility for the “adult formation” of children. The concept of offering parents support to meet the needs of children is, in theory a good concept, especially when individual parents are in need of additional support. The problem is that this Act goes too far. I refer you to Section 2953 of the law:
`(2) PERSONAL RESPONSIBILITY EDUCATION PROGRAMS-
`(A) IN GENERAL- In this section, the term `personal responsibility education program' means a program that is designed to educate adolescents on--
`(i) both abstinence and contraception for the prevention of pregnancy and sexually transmitted infections, including HIV/AIDS, consistent with the requirements of subparagraph (B); and
`(ii) at least 3 of the adulthood preparation subjects described in subparagraph (C).
`(B) REQUIREMENTS- The requirements of this subparagraph are the following:
`(i) The program replicates evidence-based effective programs or substantially incorporates elements of effective programs that have been proven on the basis of rigorous scientific research to change behavior, which means delaying sexual activity, increasing condom or contraceptive use for sexually active youth, or reducing pregnancy among youth.
`(ii) The program is medically-accurate and complete.
`(iii) The program includes activities to educate youth who are sexually active regarding responsible sexual behavior with respect to both abstinence and the use of contraception.
`(iv) The program places substantial emphasis on both abstinence and contraception for the prevention of pregnancy among youth and sexually transmitted infections.
`(v) The program provides age-appropriate information and activities.
`(vi) The information and activities carried out under the program are provided in the cultural context that is most appropriate for individuals in the particular population group to which they are directed.
`(C) ADULTHOOD PREPARATION SUBJECTS- The adulthood preparation subjects described in this subparagraph are the following:
`(i) Healthy relationships, such as positive self-esteem and relationship dynamics, friendships, dating, romantic involvement, marriage, and family interactions.
`(ii) Adolescent development, such as the development of healthy attitudes and values about adolescent growth and development, body image, racial and ethnic diversity, and other related subjects.
`(iii) Financial literacy.
`(iv) Parent-child communication.
`(v) Educational and career success, such as developing skills for employment preparation, job seeking, independent living, financial self-sufficiency, and workplace productivity.
`(vi) Healthy life skills, such as goal-setting, decision making, negotiation, communication and interpersonal skills, and stress management.
“Adult Preparation” as defined in this law belongs in the domain of parents and church. This section of the law potentially violates a parent’s constitutional right of freedom of religion without government interference. It is not the “state’s” nor federal government’s place to impose government established teachings on families or children. Children, as of yet, do not belong to the “state”. While there are many who say that abortion is not in this act it is actually very much in the Act. The interesting thing is that even if it weren't in the Act, the fact that there is total control over curriculum and education of kids regarding sex, sexual orientation, etc, abortion as an approved method of birth "control" would be taught as an approved method of sexual behavior and kids would be indoctrinated into accepting it as accepted social behavior.
A second major area of concern in this Act has to do with research. This Act is loaded with federal authorization for government initiated medical “research”. While I know that quality research is important to quality care, this Act authorizes the government to collect all sorts of information about a person (personal, financial, occupational, lifestyle, medical history and medical test results) and establish a central data bank of that information. This information can then to be used to establish “trends” in health care (trends are important) but then goes too far when it also grants the Secretary the authority to share medical/personal information to whomever s/he may designate for “additional research” purposes. One example of this license for government research is found in the following statement from the Act:
`(3) AVAILABILITY OF DATA- The Secretary may make data described in (a) and (b) available for additional research, analyses, and dissemination to other Federal agencies, non-governmental entities, and the public, in accordance with any Federal agency's data user agreements.
While there is a small safeguard in saying that information collected would not be allowed to “adversely affect any individual”, where are the safeguards to prevent that from happening? I could find none.
`(d) Limitations on Use of Data- Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual.
When it comes to research, I know hospitals and other research entities take ethical responsibilities of health research very seriously. The Belmont Report, the Declaration of Helsinki, and the ethical guidelines for medical research as established by the Council for International Organizations of Medical Science all recognize and protect the rights of research subjects with respect to “informed consent” as it relates to medical research. The “research” clauses of this law make no such guarantee (and again, this Act is loaded with “research” clauses). Information collected on individuals, ipsofacto, becomes the property of the Federal government to pass on to whom ever the Secretary wishes to give the information to for what ever purpose the government may decide. There is great danger here for a significant violation of ethical standards of medical research long held sacred by the medical profession…standards that government doesn’t acknowledge in the Act. There is nothing about “voluntary participation” or “informed consent” with respect to participation in “research” in this law…at least, none that I could find. What is interesting is that DNA is collected on every child born in the United States. While states protect that information saying it needs to be destroyed in specified years, the federal government offers no such protection. As a result you end up with a very interesting data bank of genetic information connected to biological, psychological, medical, behavioral, social, financial, education information...all of which is authorized for the government to collect and analyze. Eugenics is reality.
Although health insurance reform is necessary, this is not the Act/law to accomplish that very necessary reform. Mandatory coverage with unlimited caps will bankrupt the system. Such a mandate is not sustainable. It would almost seem that this is a deliberate attempt to bankrupt private insurance providers thereby resulting in a single payer system and government run insurance plan.
While many are saying that a lot of very good and experienced doctors will leave the profession as a result of passage of this Act, I see another major concern. This Act is designed to fill the resulting “gap” for experienced health care providers by creating a workforce of “professionals” who will be government employees providing for the future of health care. Through this Act people are encouraged to become health care providers and loans are provided for people to get the necessary training. These very same loans will be totally forgiven after ten years of paying back the loans (payments capped at ten percent of income prior to loan forgiveness) if that person enters public service and works for the government. (Taxpayers will, in the end, be paying for these “loans”. ) This is very, very strong incentive to “work” for the government and not enter the private sector. This will not necessarily guarantee quality care…what it does guarantee is a larger government and increased government control.
In addition to the above observations, this Act also creates what is called a “National Healthcare Workforce” and government run health care centers. Quality community and private hospitals will eventually be replaced by government facilities and health care providers will become government employees. It is inevitable…this Act is designed towards that “end”. Again, I encourage you to read this Act carefully. Hospitals will be replaced by government managed and/or government owned facilities. Private Christian hospitals and health care professionals guided by their own spiritual beliefs will be forced to choose between public funding and compromising their beliefs or closing their doors. Many will close their doors.
With the federal administration committed to unionization of “workers” I would also not be surprised to see all of the hospitals and health care facilities mandated to become unionized. This would be a unionization of ALL health care providers from doctors to nurses, technicians to therapists. Quality patient care, innovation, and true medical research will fall victim to a mediocre government run bureaucracy.
These are just a few of the many hidden items (that are not so hidden) in this new law. Nancy Pelosi gleefully exclaimed at a national convention of the Democratic National Committee earlier this year that “millions and millions of dollars” have already been spent setting up the entire “ IT” infrastructure for this bill through the Stimulus Bill of February 2009. This infrastructure will enable the federal government to collect medical data and personal identification information together in a centralized federal data bank for access by the federal government.
Everyone is saying this bill won’t take effect for another two years. They are wrong! The entire infrastructure for a “fundamental transformation” is being established now! This is an infrastructure which will result in the loss of many freedoms… freedoms guaranteed by the United States Constitution, freedoms we have all come to take for granted. By itself this Act is an abomination. When taken in context with other federal government takeovers, mandates, regulations (when it can’t get Congressional approval) and obvious socialist agendas, it is even more frightening. Modification of this legislation is not the answer.
One of the things that is particularly interesting is that this Act is designed so that it can not be defunded as many have suggested. This act interacts and is interconnected with all of the other legislation that has passed last year and in years before that. As I said before, this act is all about the "children" of our country. There is now a movement for the state to assume responsibility for childhood education from "P" thru third grade. "P" is no longer "pre K" .... "P" is for "prenatal". The goal is to get children from parents.
Again. I really wish I hadn't read the Act. I wish I hadn't read the acts passed after that one. But I did... and once my eyes were opened....I can not be silent about the truth contained in these acts. As a church, for those that follow the Roman Catholic Church...we will be entering into a time of great darkness and persecution. (My parish has already had their day care center closed a few years ago because of the state mandating that they have a right to control curriculum. My parish has maintained that they do not have a right to be involved in church teachings. This is only the beginning.)
P.S. With regard to the fact that the IRS will be the ones monitoring your "purchase" of health care insurance....as I thought thru what this law is really all about...setting up infrastructure, it suddenly made sense. As the system collapses, and the federal government replaces it with single payor /federal health care, the IRS infrastructure will be in place to be sure you pay your newly created health care tax to pay for all of this. NOTHING IS FREE AND IT IS ALL ABOUT INFRASTRUCTURE.
What you are denigrating is
What you are denigrating is what the U.S. Constitution requires. The Catholic Church may not TELL our government or any users of health care (the is, everybody) that the law must conform to Catholic teaching. We cannot TELL others to honor its rigid rules about birth control and we cannot even TELL others to believe the same things about abortion that the Church teaches. And we surely can't TELL parents who aren't Catholic what to teach their children.
That said, most nurses I know favor a single-payer, Medicare for All plan like Canada's. It would save us $400 billion per year while making sure that not one person goes without care.
The second-best solution would be for the state of Massachusetts and the current administration and Congress to take another look at the European system it is only partially copying. (We left out the important part.) In America, we can't stand to let guv'mint "take over" health care, so we have left the insurance and drug companies in charge. Prices and premiums rise yearly; coverage does not, and often shrinks as insurers find new ways to deny payments.
In Switzerland, Norway and some other European countries, the government maintains a private system of insurance but does not let that industry run the system. All citizens must be insured, must purchase from an "exchange," and can count on government to pay their premiums if they are poor. No one is left without care.
The difference that makes the difference is that government studies health care costs each year and tells providers what they can charge for any service and then tells insurers how much they must pay to the providers. There are no copays or deductibles. Premiums are also set each year to ensure that insurers can pay current costs completely. These countries spend about half what we do because government knows it must regulate the system or pay the same excessive costs as we do.
So how do insurers compete? On the basis of CUSTOMER SERVICE. Wouldn't that be refreshing????
Bernice: I am not
Bernice:
I am not "denigrating" what the Constitution requires. I am upholding the Constitution. The Constitution limits government and government actions and power. The health care act is actually in complete violation of the Constitution on so many ways.
I am also not requiring that all follow Catholic teaching because it is Catholic teaching. I do, however,maintain that there is a universal truth that life is sacred. The Constitution talks of "life, liberty and justice for ALL"..."ALL" would include those in their mother's womb. I also believe that a Catholic has a right to not be obligated to pay for what a Catholic believes to be immoral and a violation of the sanctity of life. If another "citizen" believes in abortion, they can pay for it if they want, but a Catholic who believes abortion to be murder should not be obligated to support it nor pay for it. (I also believe some of the current research that is being done to be immoral -- ie combining human genes with cows to create cows that offer "human milk", and believe people should not be required through their tax dollars to support such abomination )
I also do not require everyone in the country to teach their children "catholic ways" but I do require that the government allow catholics to be able to teach their children their faith and beliefs. The health care act does not allow that to happen. It will dictate what children will learn based on government established criteria. (it is already happening across the country.) With respect to the Catholic Church "telling" the government about health care, I do believe it is very much the duty of every citizen to speak out to their government about basic morals and principles that protect life and freedoms. This health care act violates so many basic principles of ethical standards of practice as they relate to medical treatment, research, education and freedom.
With respect to health care and health care costs,yes, something different does need to happen in our country other than the current system. I will not argue that point, but no, a single GOV run health care system is not the answer. With respect to private insurance companies, this Act is designed to destroy them, hence leading to the single payor system. (Not to worry. Government infrastructure will be in place because that is what they are working on right now...government infrastructure.) And far from promoting valuable creative advances in patient care, this Act will stifle it in ways that we can not even begin to imagine. (With government being in the position of deciding what is appropriate medical treatment, I am left wondering what medicine would be like today if this had passed 15 years ago before massage therapy, music therapy, acupuncture, etc were considered approved and appropriate treatments. It has been an uphill battle to get those modalities recognized as it is. Herbal medicine will be very much threatened as it is as a result of this act as well as the "food safety act"!)
The problem about the health care act is that it is so much more than about costs and care...it is about manipulation and control -- not just of medicine but of people. It is about giving up so many freedoms that we, as Americans have taken so completely for granted. It is also about promoting mediocrity in health care and lowering the bar of excellence.
With respect to other nurses, yes, ALL of the nurses I know hate everything about anything that restricts patient care. I do too. But this Act WILL NOT GUARANTEE patients receive everything and anything. With respect to nurses agreeing with this health care act, I do challenge nurses to actually sit down and read this act...more than that, I suggest that they are obligated and duty bound to read this act and know what it really says...not just what the talking heads say it says. I also challenge them to read the act with a knowledgeable perspective of what health care is all about and not just read the words but use critical thinking analysis of what this act says. Again, it is not what the talking heads say, nor what it is being promoted as saying. With that said, I will say that the nurse vote has been very much bought by this administration because, in truth, as a profession, this bill has EVERYTHING a nurse could possibly want for the PROFESSION of nursing. It holds "nurses" high and promises us everything. But...be careful of 'promises' because, again, it is not all it seems to be and pretends to be.... and most importantly of all...it is not about the "patient"!
And yes, wouldn't it be nice if everything we did were based on "customer service" founded in the believe that when we care for another person we are actually caring for the body of Christ.
Happy Easter!
The health care numbers game
The health care numbers game is not that different than Wall Street shenanigans in its method and outcome. For most people attempting to comprehend the manipulation of health care costs is as mind boggling as attempting to understand derivatives and other odd Wall Street constructs. The greed factor of deregulated profit in a 'privatized' system is what ultimately drives up costs and breaks budgets, not consumer demand. One example of how this works... The current rise in gas prices more closely correlates to market speculation than the "demand" of a largely unemployed or under-employed population who cannot afford to buy it. Corporate profiteers are the 'wizard behind the curtain'.
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The only means to get health care costs under control and stop the numbers manipulation that pits human beings against each other based on economic affluence and insurance, or lack thereof, is a publicly funded single payer system covering everyone, and government using its clout to negotiate for fair pharmaceutical prices. Medicare's current cost problems are not the fault of that payer system, it is the fact that private for-profit corporate systems — the true "death panels" — manipulate the market, insure only the profitable, and driving large numbers of uninsured into non-cost-effective emergency departments that generate enormous bills they will never be able to pay (this contributes significantly to the numbers manipulation on hospital bills for the insured... to recover receivables losses in a vicious cycle). The only winners are the corporate gamblers gaming the system behind the smoke and mirrors while everyone else sits at the health care slot machines hoping for an eventual 'win' that will never come.
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It's a lie that medical innovation and research are inevitably so costly that only the affluent should or could have access to it, like say, a yacht or second home in the French Alps. As long as the electorate continues to buy the lie, corporate king-pins and their politician water-carriers will continue to sell it, while both profit handsomely from an immoral and economically unsustainable sickness-and-death-for-massive-profit system that other civilized countries have abandoned. Notably, these same CEOs and politicos are obscenely overpaid, well-insured and well-perked, so they have no motivation to change the status quo that is favorable to themselves both economically and politically.
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Perhaps a universal system
Perhaps a universal system modeled on the veterans hospital system, but for everyone. Not a perfect system by any means, but more cost effective than what we are enduring now.
Most European countries have government medicine. Ate they lagging behind us in medical technology or pharmaceutical research because prices are controlled? I don't think so.
Apparently the retired
Apparently the retired medicare executive worked in an area that had nothing to to with billing. This structure is a direct result of Medicare cost reimbursement. Also, Medicare requires each caregiver to bill for services generally at a rate above Medicare and to send the patient a copy of the bill with such "charges" - and the bill must be for such charges unless they have a good reason not to do so, e.g., a contract with an insurance company (NOTE the bill to patients must show charges, not the actual contractual amount). Hence, insured patients get the bill, but are paid in accordance with the contract. Only the uninsured are expected to pay charges - though if you could negotiate a cash payment, you might get a deal. Most uninsured can't pay much of anything, so their bill is written off. Only the poor scmhucks without insurance, but with some money, get the full charge. Naturally, the Hospital has to go after that schmuck because otherwise the charges would look phony.
So each hospital, e.g.(we could go on about Doctors, Home health, rehab, etc etc), has a "charge master" incorporating each service, supply etc provided. Each patient, medicare or not, will get a bill setting forth "charges." "Charges" in a twist of jargon, has little to do with what a hospital is paid. Are the glories of the "contractual adjustment"!! The contractual adjustment is the difference between the charge and the actual payment. Naturally, that difference varies from payer to payer and in the aggregate varies on the number of payers in each group.
However, in the days of yore of cost based reimbursement, the Hospital got paid a % of "charges" for outpatients or a % of cost for inpatient care. Hence, hospitals had the incentive to crank up the charges. Other mechanisms were in place to try to control costs. Other payers paid a lower percent of "charges." When the current PPS system came in some years back, it applied only to inpatients. So hospitals continued to get a percent of charges for outpatient services. As fixed payments based on DRGs, etc., have filtered in the old necessity of having a charge based bill has not been eliminated - and some few payers continue to pay on a % of charges - so we see this bill.
As for differential in prices, different market power, etc certainly effects what each provider get paid. Some providers have the ability or power, or both, to negotiate a higher payment. But, each provider sets his own charge - which may, but probably doesn't, affect what he/it gets paid.
Don't think for a second that some are not thrilled with this byzantine system - and others are horrified and others are simply mystified. But, any medicare executive that can't figure it out is either disingenuous, uninformed, at low level or not working in the reimbursement arena. It certainly is the CPA full employment system.
Regardless of how the rules
Regardless of how the rules are changed, and how often, the players still try to stay ahead and game the system. In my day "usual and customary" was the standard for physician payment. I guess that just shows how old I am.
Perhaps a "for profit" system is not the best way to provide healthcare services in a fair manner.
So, do the uninsured have to
So, do the uninsured have to pay $60,000.00 for the same procedure because they do not have an insurance company or program to haggle for them?
And people think we do not need health care reform!
By and large many of the same
By and large many of the same people who fought health care reform were the same folks who advocated for the billionaire's Bush tax cut extension,supported the GOP's slash n' burn budget cutting ideas which have gutted the budgets of many health and safety-related regulatory agencies. Don't count on these people having any ideological buyer's remorse because a lot of them have become latter-day devotees of Ayn Rand's political ideas. And wouldn't you know it, Paul Ryan has been urging his acolytes to start reading Rand's "Atlas Shrugged." Maybe it's his "Rx" for helping people to get over any guilt they should feel for maintaining such selfish outlooks concerning the dismantling of the social safetynet. It's not a far leap from embracing the ideas of Rand to pushing for a voucher system to replace Medicare for people under 55. And to think the lame-stream media praised Ryan for his "boldness" and "courageous" plans! It doesn't take any courage to turn back any clocks; much less boldness. Baldfaced temerity and/or outright arrogance in his desire to play God with the lives of so many people and insult them with his "health care plans" as being little more than the equal to passing out discount shopping coupons to very cost-conscious grocery store customers.
There's nothing "new" in this supposely new idea of his. Republicans have been pulling this nonsense for almost 30 years and Ryan's Medicare plan is very similar to W's that the latter tried floating when he ran in 2000.
Bill, as a Presbyterian, can
Bill, as a Presbyterian, can you tell us....When will Presbyterian hospitals stop doing abortions?
Bill, abortion is the greatest holocaust in history. You cant deny that. A holocasut is the mass murder of innocent humans, 50 million in the USA alone. So have your evil cult stop this holocassut.
Thanks for this article.
Thanks for this article. Recently had a similar experience for an asthma test for my son. The Lab at the Catholic hospital here could see from its computers that we owed them $200 deductible, and collected this up front before we could see them. They failed to answer the phones or give us the results. We had to ask that they be sent TWICE. Once the person in the lab told me I had the wrong extension and hung up on me. Then they billed our insurance company another $1,300. Then another pulmonary specialist WHO NEVER SAW OUR SON sent us a bill for interpreting the results.
Meanwhile this hospital has the CEO answer the phone (robo voice)and tell you how great this Catholic compassionate care is. Long ago, however, the aging sisters turned over their ministries to the MBAs and bean counters. There are very few hospitals still under the "control" of the nuns.
Between co-insurance, co-pays, deductibles, noncovered expenses, what is billed to your insurance (and what ultimately is paid) and how many "providers" claim to have some stake in sending you a bill, it is almost not possible to understand of financially negotiate the "system." Shame on them all.
I worked as a computer
I worked as a computer programmer at a hospital for over twenty years. We would run every hospital\patient claim thru some special software that would 1 - examine every lab test, charge and procedure, 2 - compare against the physician(s) working diagnoses and 3 - come up with a final diagnoses that would allow for maximum reimbursement from insurances. If the hospital is only going to receive pennies on the dollar and must absorb the difference (not bill the patient); then they simply try to generate the highest justifiable bill. God help the patient who walks in paying out of pocket.
It was always interesting to watch an inpatient's working diagnoses change from day to day dependig on tests ordered and time in hospital.
The reality is; many hospitals could not survive if engaged in straight forward billing unless they had some other source of income. This is especially true if the hospital treats the poor or aged. I don't like the shenanigans; but they are a fact of existance.
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