Doctors selling their practices have an unpleasant surprise for their patients; unreasonably high prices according to the NY Times.
Anyone who has ever gone to the hospital for a test, an overnight stay, or just an emergency room visit is likely to have a story about unreasonably high prices for the work performed. Unfortunately, hospitals have been given economic clout and a free pass on pricing their services because they reason, doing things in a hospital just cost more to perform and they are required to be there 24/7.
A number of years ago, Medicare began to look at their reimbursement policies and decided that many specialists in private practice should be paid at a more appropriate level, reducing the fees that these doctors (e. g. cardiologists) were able to charge, yet, when the same services were performed under the roof or auspices of a hospital, the fees were markedly higher and sanctioned by Medicare.
This resulted in hospital systems buying cardiology and other specialty practices which increased the amount of money both the doctors and the hospitals made. Since Medicare allowed for this, many health plans followed this model resulting in all of us paying much more for the same services.
Recently, my daughter had a lactose tolerance test that in most offices is $100 dollars or less. Our plans allowed the rate for the test was $70 but since the doctor sent us to St. Barnabus to have the test done, they charged and were allowed under the fee schedule $529 for the same hour breath test, an absurd amount. As many of you now feel more of the cost of care coming out of your wallet, I am sure you can relate to my outrage, since we only went where we were told to go for the test and trusted that we would be treated fairly.
Unfortunately, there are few places you can now be treated fairly for a fair price in our current healthcare system; Our office, your primary care doctor (their prices are reasonable usually and they have competition from the walk-in clinics). The rest of the system is the wild west of pricing and when you are scared and thinking you may be having a life-threatening problem, the last thing most of us think about is the cost of going to the ER. Basically, they are taking advantage of our fears, whether they are real or not.
The NY Times recently discussed this dilemma, which is unfortunately due to poor policy decisions, and little control of what hospitals charge. Check out the article here
When hospitals buy doctors’ offices, and patient fees soar
Imagine you’re a Medicare patient, and you go to your doctor for an ultrasound of your heart one month. Medicare pays your doctor’s office $189, and you pay about 20 percent of that bill as a co-payment.
Then, the next month, your doctor’s practice has been bought by the local hospital. You go to the same building and get the same test from the same doctor, but suddenly the price has shot up to $453, as has your share of the bill.
Patients around the country are getting that unpleasant surprise, as more and more doctors’ offices are being bought by hospitals. Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place.
This week, the Obama administration recommended a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients.
In the dry language of the annual budget, the White House asks Congress to “encourage efficient care by improving incentives to provide care in the most appropriate ambulatory setting.” In normal English, that means reducing financial incentives that are causing many doctors to sell their practices to hospitals just to take advantage of extra revenue.