Another day, another proof that medicine is a business, as if we needed any more proof. Many hospitals are hiring staffing companies to supply doctors to work in various parts of the hospital. This is a particularly common occurrence in emergency departments. By hiring a staffing company, the hospital does not have to locate and contract with physicians, handle vacations, scheduling, benefits and the like. It is simple for the hospitals. Hire the staffing company and let it do the rest. Unfortunately, it may also be very expensive for the hospital’s patients.
Most hospitals have negotiated prices with the local health insurers. Having negotiated prices, these hospitals are now “in network” for the customers of those health insurers. Amounts charged by “in network” providers are discounted by agreement. If a patient sees a provider who is out of network, not only will the price not have been discounted, there is usually a penalty in the form of a requirement that the patient pay a higher percentage of the bill than if the provider were in network. It is very important for the patient to be treated by an in network provider.
Here is where the problem with staffing companies arises. Even if your hospital is in network, the staffing company’s doctors may not be. As reported here and elsewhere, this has resulted in some nasty surprises when patients visiting the emergency department at a hospital in their network receive a large out-of-network bill directly from the emergency physicians. The staffing company mentioned in the stories linked above, Emcare, is the largest supplier of emergency physicians in the country. It supplies emergency physicians to a number of hospitals here in the Phoenix area. Very often, its physicians are not in network. Emcare sends bills which are not only out-of-network but which reflect substantially higher charges for the same services that were provided by whoever ran the emergency department before. In at least one hospital in the state of Washington, the number of emergency department patients who required what the doctors claimed was the highest level of medical care increased by almost five times after Emcare took over the emergency department. Using billing codes, the higher the level of care provided, the more Emcare charges for the services of its doctors. It would be surprising if the patients at this hospital became five times sicker once Emcare started running the emergency department.
Emergency care is just that – emergency. When we need emergency care, we don’t have the luxury of time to investigate which hospitals are in network and whether all of the doctors who will see us at an in network hospital are in network as well. There is very little we can do to protect ourselves from out-of-network doctors hiding in hospitals that are in our networks. I wish I had a better answer for you. The best I can do is suggest that before that emergency arises, you find out which local hospitals are in your network and whether their emergency physicians are in network as well. My only other advice is, “Don’t get sick and need emergency care.” Good luck with that.
