Fix the medical bill mess

We the people of the United States of America desperately need a leader who possesses common sense, business savvy, and commitment to make America great. I’m a patient and physician who lives in the trenches of real life medicine and sees first hand the casualties of the government assault on America’s patients, physicians, the patient- physician relationship, our code of medical ethics, and the U.S. economy. The Affordable Care Act (Obamacare) and the Medicare Access and CHIP Reauthorization Act (MACRA) are massive government redistribution schemes and power grabs that rob patients of their choice of doctors, health plans, and individualized treatment, rob physicians of their autonomy to freely care for patients, and rob taxpayers of $3 Trillion per year, most of which is irresponsibly squandered in a cesspool of administrative incompetence and political pay-to-play, best called money-laundering, as political elites, special interests, and their lobbyists prey on our very lives. Rare few- patients, physicians, politicians, administrators, and bureaucrats included- even understand what is going on. Architects of these laws intentionally made them extremely convoluted in order to “slip one over on us”, the American people who they regard as “stupid,” as espoused by Obamacare architect Jonathan Gruber. Bad law is layered upon bad law and confounded by out-of-control agency rule-making. This must end.

Personally, as a physician, current healthcare law makes it ethically untenable for me to comply and makes it increasingly difficult to even stay in business. I have severed all ties with third party insurance companies and have opted out of Medicare choosing instead to serve my patients directly. At the peak of my career, I could be caring for substantially more patients, but federal laws, rules, and regulations restrict my ability to practice medicine, my life’s calling that required 12 additional years of arduous education and training after high school. What a waste of time, resources, and lives. As a patient, my insurance premiums, deductible, copay, cost sharing and medications are exorbitantly more expensive, while my visits to my doctors (those who have not left medicine altogether) are impersonal, short, and consumed with nonsensical electronic health record data gathering and reporting.

Here is an example of something that can and must be fixed.

A fifty-something year old patient sustained a retinal detachment, which was successfully repaired in a hospital outpatient department. He thought he had signed up for Healthy Indiana, his state’s Obamacare plan, but can’t find any information from anyone about his benefits or status, much less has he been able to communicate with anyone. So, the hospital deemed him uninsured, sent him a bill, and gave him a 40% “self-pay” discount. The bill he received from the hospital outpatient surgical facility alone was $103,336.96, which was discounted $41,334.18, for an adjusted payment of $62,002.18. This is beyond outrageous. That the hospital accounting department sent this to the patient with so many obvious mistakes and inflated charges is evidence of a systemic lack of understanding and rampant incompetence.

I volunteered to review the bill for the patient. First off, the patient was charged for 54 half hours of surgery ($74,844.00) instead of 5.4 half hours ($7,484.40)- accounting for an overcharge of $67,359.60. This correction immediately brought the bill down to $35,977.36, which leaves the patient responsible for $21,586.42 after the 40% discount is applied. In addition to the hospital’s facility fee, the surgeon billed $2739.93, and the anesthesiologist billed $2565.00. All in, the patient now owes $26,891.35. Medicare would have paid around $2000.00 to an Ambulatory Surgery Center facility, and commercial insurance allowables vary from $2000.00 to $4000.00.

Had the patient had his retinal detachment surgery performed at an ambulatory surgery center instead of a hospital outpatient department, the facility would have accepted an insurance allowable of between $1800.00 and $4000.00 ( a private physician can negotiate even lower transparent fees for uninsured patients or patients whose deductibles are prohibitively costly) while a retina surgeon would charge $1800.00 and an anesthesiologist around $1500.00, for a total of between $5000.00 to $7000.00- 20-25% of the cost in this case.

A few charges stand out on the itemized hospital bill and exemplify more of what is wrong with the system. Povidine-Iodine 5% solution is used to clean the eye prior to surgery. The hospital charged $1502.64 for a 30 ml bottle of this, times 2 bottles, totaling $3005.28; we purchase this exact product in this size for $6.05 at our Ambulatory Surgical Center (ASC), times 2, for a total of $12.10. The hospital charged $688.40 for a 3 ml bottle of Moxifloxacin ophthalmic eyedrops, (times 2 bottles for a total of $1376.80) which we purchase for $149.00 at our ASC. Every item on the hospital bill is usuriously inflated in this fashion.

Why does the hospital artificially inflate the bill to this extent and then accept a fraction from the self-pay patient, an insurance company allowable, or Medicare allowable? ($30,000 compared to somewhere between $2000 and $4000.) Because, in effect, they are fabricating losses, which they can then report to the government as having provided a vast amount of uncompensated care, for which they receive credit, and maintain a non-profit status. In this case alone, if the patient ultimately pays $4000 instead of the $35,977.36, the hospital will report that it provided $31,997.36 in uncompensated care, will stay non-profit and pay no tax. And then there’s the hospital-big insurance-big pharma cartel, that inflates prices to line each of their own respective pockets.

I suggest this “self-pay” patient aggressively pursue his status with Healthy Indiana- if he has been paying premiums, the insurer must deliver. If it turns out he does not have benefits (the ineptness of the exchanges, enrolling, and staying enrolled, is another story), he should negotiate with the hospital and his doctors. Perhaps $3000.00 would satisfy the hospital, $1800.00 for the surgeon, and $1200.00 for the anesthesiologist for a total of $6000.00- a far cry from $26,891.35.

This convoluted system can and must be fixed. We must educate ourselves about the way insurance works and the way the “bill” relates to the “allowable” or discounted rate. Then we must make wise choices. Choose facilities and doctors who have transparent, fair, reasonable fees and work with them directly, outside of 3rd party agreements. Change the perverse tax code that rewards hospitals with a nonprofit status for alarming and abusing patients with falsely inflated bills. Fix bad policy that allows hospitals to be paid more than ASC’s for doing the same work. Be your own best advocate. Read and understand medical bills and address problems with your physicians.

Fixing the mess starts with electing leaders who have common sense and business sense, and who understand healthcare law and will work tirelessly to repeal and replace Obamacare and repeal MACRA. Yes, we can fix this. And we must. Vote accordingly.

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