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June 5, 2013 By e-Patient Dave 9 Comments

“Chaos, behind a veil of secrecy”: Show me the cash flow

April 2016 update
April 2017 update

Original post here was June 2013. Or, jump to the Nov 2015 update below.


Latest in my series Let patients help, cost-cutting edition

I’ve blogged several times about the greatest truth I’ve learned about the business of medicine. It’s the title of a 2006 Health Affairs article by Princeton economist Uwe Reinhardt: The Pricing of US Hospital Services: Chaos, Behind a Veil of Secrecy.

The cost chart at right shows what’s happened since Reinhardt’s paper appeared, in the middle of the chart. It’s what you’d expect if slush is flowing around with nobody watching.

Today I was reminded that it ain’t just hospitals. :-)
______

Last week I got my annual checkup. There were two separate problems in my hospital’s appointment system, so I ended up leaving too late to get the simple lab work my doctor had ordered; I said I’d get it done at a local lab.

Today I visited AnyLabTestNow, a chain with a local office. I called ahead, and for walk-in self-pay, it’s $49 for the chemistry panel I needed (Calcium, CO2, etc) and $49 for the cholesterol, total $98. And a $10 off coupon, on the site! Just $88.

Or not.

[Read more…]

Filed Under: cost cutting edition, The Big Ugly 9 Comments

March 11, 2013 By e-Patient Dave 4 Comments

The Big Ugly continues: “Hospital charges bring a backlash”

Here’s the next episode in what I’m starting to call “The Big Ugly” – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.

Medicine’s certainly not going to die – we need it – but the Institute of Medicine says (see links below) we have massive overspending, and when the overspending shrinks, that too will hurt.

Today’s Boston Globe has the newest item: Hospital charges bring a backlash:

Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay.

Hospitals say the charges cover their overhead, but the fees are sometimes added to the bill even when patients are treated in offices miles away from the medical centers. …

The Globe published a story in January about a patient charged $1,525 in operating room and facility fees for a minor skin procedure. Yeah, the doctor charged $354 for her services, and the hospital (Lahey Clinic) added $1525 of overhead. Another patient is quoted as sounding like (amazingly) an empowered consumer:

“I am willing to spend my money for my doctor — I am getting expert care,’’ said the New Hampshire resident. “I am not willing to pay $500 to sit in a waiting room.’’

Watch for more stories of overhead charges, and more, as organizations gasp for air, and ask consumers to bear the burden. See other stories in the links below, like the chain that put its E.R. docs on quota.

What to do: [Read more…]

Filed Under: cost cutting edition, Health policy, The Big Ugly 4 Comments

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