Taxpayers aren’t the only ones who get hurt when doctors, hospitals and shady characters get together to game the system. Patients sometimes end up with surgeries or treatments they don’t need, which don’t help them, and which may kill them. In the latest in an excellent series of articles on health care costs and the human toll of fraud and abuse, The Wall Street Journal on Thursday, February 9, 2012 published an article about a convicted racketeer who worked with two small hospitals and doctors in the Long Beach, California, area to bring in spinal surgery business. The former jailbird allegedly made millions in consultation fees from the hospitals and from selling metal implants for the surgeries to the hospitals at huge mark ups. He allegedly used the huge profits from the sale of the metal implants to pay kickbacks to doctors who would agree to refer their patients for spine surgeries at the hospitals. He is the subject of a federal investigation, which may soon result in an indictment.
As a result of his efforts, the two, relatively small hospitals became the largest billers to the California Workers Compensation system for spine surgery by a big margin. The cost to the system of spine surgery has gone up dramatically, increasing from 30% of all costs in 2001 to 40% in 2010. At the two hospitals in question, the average total billings for a single spine surgery were about $175,000.00.
It doesn’t take a brain surgeon or a spine surgeon to know that if there is big money to be made from a surgery, there is a strong temptation on the part of the surgeon to do the surgery. The Journal article recounts the sad story of a woman with a neck injury whose first spine surgeon did not recommend surgery for her. Somehow she ended up with one of the surgeons who operated at the two hospitals. Even though he and they were 150 miles from her home in central California, he scheduled her for surgery at one of the Long Beach hospitals. According to the article, the surgeon, who performed a three level neck fusion on the woman, used a product which the FDA warned against using in the neck area because it could compromise breathing. The day after surgery, the patient experienced difficulty breathing and died. The billings for her surgery and hospital stay were $177,138.00. All participants deny fault.
The other Wall Street Journal articles in its continuing series on billing patterns in Medicare show similar instances of higher billings and increased use when doctors own expensive machines or own companies which sell products to hospitals which the doctors then use in their surgeries. One article studied the use of new and very expensive beam radiation machines used by urologists to treat their patients with prostate cancer. A single course of treatment with the machine was typically billed to Medicare at $40,000.00. The article found that patients of a urology group which owned one of these machines were much more likely to get this expensive treatment than patients of urology groups that didn’t own a machine. The urology groups which owned the machines made very large profits from them.
All of this leads me to a recurrent theme: Medicine is a business and you are the customer who is being sold goods and services. Doctors get it. Hospitals get it. Device manufacturers get it. The only person who doesn’t seem to get it is the patient who often accepts what the doctor tells him or her without question. The patient accepts without question the truth of statements which he or she would never accept if the transaction involved the sale of a car or a similar product. Ask questions and get second opinions. Don’t believe everything you are told just because it is a doctor telling you.
