When you think of people who scam the public, you don’t normally think of hospitals. Sure you may think they charge too much or don’t live up to the promises they make to provide health care benefits to the community, but you don’t think of them as scammers. Maybe you should start.
Two recent stories about hospitals doing sneaky things in the pursuit of more money caught my eye. As anyone who has been reading this blog knows, our nation’s health care system is a disgrace. We pay more per person than any other nation on earth and get care that is far from the best in the world. We have giant insurance companies siphoning billions of dollars each year from the health care delivery system. We subsidize drugs for the rest of the world by allowing Big Pharma to charge us the highest drug prices in the world. We still have millions of people who are uninsured and, many of those who are insured have plans that don’t provide good coverage. The last thing we need is hospitals taking even more advantage of us.
Rural hospitals are in big financial trouble. They don’t have enough insured patients to be able to cover all of the expenses of running a full-service hospital. Many of them are folding up and going out of business. The hospitals scamming us are not these rural hospitals, but their often well-off big city brothers and sisters.
Some hospitals are setting up “obstetrics emergency departments” (OBEDS) and requiring any woman presenting to the hospital for delivery of her baby to first be seen by someone in their “obstetrics emergency department” before being admitted to labor and delivery. Admission to labor and delivery has always required a quick examination to be sure that the woman is actually in active labor. That triage examination was part of what you paid for when you paid to have your baby delivered at the hospital. Now hospitals are seeing a way to make extra money by making the labor and delivery triage examination a separate event for which they charge separately. The cost of these “emergency” visits seem to range from a low of $300 to a high of $1,300 and the visit may be described in emergency terms on the bill to increase the likelihood that insurance will pay it.
You don’t need to actually go to the emergency department to be hit with an OBED charge. Many of these OBEDS are in the labor and delivery area of the hospital itself and are separated from it only by a curtain. Patients may never be told that they are receiving “emergency care,” and may never realize it, but they get billed for it anyway. Investigations into this practice have found that it almost always occurs at hospitals that are partnered with our old friend, private equity.
The second tricky practice involves urgent care centers. Urgent care centers have a definite place in the health care delivery system. They are lower cost alternatives to emergency departments and offer care for less serious medical issues. At least it is supposed to be a lower cost alternative.
A recent story in a national newspaper by a mother, who happens to herself be a doctor, described a trip to an urgent care center for her daughter. The daughter had fallen from her bike and hurt her ankle. After a week, it was still sore so mom decided to go to urgent care for an x-ray. An urgent care x-ray usually costs only $100 or so. An x-ray at the emergency department will be many times that amount. Mom was happy to learn that her daughter did not have a fracture, but was unhappy when a bill arrived for $1,300 for the x-ray. Unbeknownst to mom, the urgent care center was affiliated with a local hospital and charged hospital rates for the x-ray.
When questioned, the hospital took the position that the urgent care center was actually an outpatient department of the hospital performing hospital functions and eligible to charge at hospital rates. Since these offices may be nowhere near the parent hospital, patients may not realize that as far as the hospital is concerned they have entered its doors and will be charged hospital prices.
Many hospitals are purchasing doctors’ practices and calling the doctors’ offices hospital outpatient facilities. With the new name, the doctor may be providing the same treatment and tests as before but now the hospital charges a lot more for the doctor’s care on the grounds that it was now being performed in the hospital.
Hospitals are forcing us to play Whack-A-Mole. Every time the government or regulators put an end to one abusive hospital practice, they dream up another. This has got to stop.
