Sunday, January 10, 2010
Metro columnist Dan Casey: Where to start fixing a farce?
Dan Casey is The Roanoke Times' metro columnist.
dan.casey
@roanoke.com
981-3423
Dan Casey
Recent columns
- There's a slip twixt cup, lip for Roanoke coffee shop owner
- 82 years of food fit for the King
- At work, on floor, in life: Rick Schmitt had all the right moves
Read Dan's blog
There are so many things fundamentally wrong with our health care system that it's hard to know where to begin.
The one we will deal with today is billing -- specifically, hospital billing. For that, allow me introduce you to Florence Rea-Wright of Martinsville.
The plainspoken retired schoolteacher and real estate agent thought she had pretty much seen it all in her 66 years.
Then she got the bill for a recent visit to the emergency room at Memorial Hospital of Martinsville and Henry County.
It was early in the morning on Nov. 21, a Saturday, when Rea-Wright spent two hours in the hospital's emergency room because she believed she was experiencing a life-threatening allergic reaction.
That had happened to Rea-Wright once before. Her allergist (since retired) cautioned her to get to a hospital fast if she ever felt that swelling inside her throat, because if her airway became blocked, it could kill her.
What is killing her today is the bill. It was $1,223.96.
I know what you're thinking: That is cheap for a life, right? I suppose you're correct about that.
By the same token, $500 for a can of beans is cheap, too, if it prevents a starving person from dying. That doesn't make it right, though.
This is not exactly about overcharging, though. It's more about a farcical health care billing and payment system that exaggerates fees, then accepts small fractions of them as payment.
And the more you listen to Rea-Wright and the hospital's administrator, the more you realize how wrongheaded and crazy that system is.
When she walked into the ER, Rea-Wright was seen by two unpaid student trainees from Patrick Henry Community College. They were supervised by a registered nurse.
One told her he was 18, the other looked "no older than 21," Rea-Wright said.
They took her to a curtained-off cubicle in the ER. One of them attempted to insert an IV port into her arm. That took a few tries and left Rea-Wright with a bunch of bruises. The nurse came to her rescue.
They gave Rea-Wright some oxygen, and (according to her bill) five different cheap medicines such as Benadryl via an IV drip. They left her mostly alone on the gurney, although the student trainees checked on her occasionally, she said.
Later, Rea-Wright said, a doctor saw her for no more than 15 minutes, felt her throat and wrote her three prescriptions. She was discharged within two hours and went home.
Then she got the bill in December. Actually it was a copy of the bill the hospital sent to Medicare. You and I pay those.
From the itemized bill that the hospital furnished me, I can tell you that the fee for Rea-Wright to merely walk into the ER was $293.75. For the IV and the IV therapy, the hospital billed $626. The medicines cost $75, and other incidentals such as a disposable blood-pressure cuff and an oxygen sensor made up the difference.
Joseph Roach, the hospital's CEO, said the bill was reviewed and deemed correct. Medicare (I mean you and I) paid the hospital $336.82.
The hospital will write off a little less than $900 if it hasn't done so already.
Roach, who struck me as a genuinely honest and helpful guy, noted the hospital would have been paid more if Rea-Wright had private insurance -- maybe $450 or so, depending on the hospital's contract with the insurance company.
(At Memorial, he noted, someone with no insurance would pay the same as whatever an insured person would pay for the same service.)
This begged the question of why the hospital billed the higher amounts in the first place.
"So the billed amounts are phony?" I asked.
"It's not phony," Roach replied.
That led us into a Byzantine discussion of something called the hospital's "charge master," which is a list of standard fees for every item a hospital uses and each service it provides.
Every hospital has one, Roach said, because every hospital always has to charge the same dollar amount for an item or a service -- such as $20 for an aspirin or a Band-Aid.
This applies even if a hospital knows there's not a prayer's chance in hell the insurance company will pay that much.
"Can I explain all of this?" Roach asked frankly. "No."
The conclusion I arrived at after our chat was this: Hospital bills and reality are mutually exclusive concepts. (The same goes for many doctors' bills, by the way.)
They're all about as "real" as the emperor's new clothes in the Hans Christian Andersen fairy tale.
The moral of that story has to do with how easily we fool ourselves.
And that, it seems, is exactly what's happening with the health care debate in Washington right now.
If a hospital administrator can't explain why his emergency room has to bill $1,200 to collect $300, it's because the problem hasn't yet been defined.
And if that's the case, how the heck can Congress fix it?
