Tuesday, March 27, 2012

Hospital 'Lobby' Takes on New Meaning

If you're over the age of 50, you probably know that AARP specializes in warning seniors about scams that can end up costing them their life savings. Perhaps AARP should be letting you in on what seems to be a scam run by your local hospital--one that affects not only seniors, but others, too.

I recently checked the cost of some potentially life-saving heart/stroke prevention ultrasound tests. A carotid artery screening that costs $60 at a non-hospital company (one of the traveling health test companies - Lifeline Screening, Inc., in this case), goes for (I hope you are sitting down) $1,931 at Boulder Community Hospital's Imaging Department. The aortic aneurism ultrasound screen, also $60 at the non-hospital company, is billed at $995 by BCH.

This seems off the charts to me and a highly non-transparent way of dealing with the problem of who pays the costs, who has insurance, how much insurance rates are, and all that flows from that.

Understandably, I couldn't remain silent when I spoke to the scheduler who quoted me the figures, so I gave her the $60 price at Lifeline. She rather graciously but somewhat edgily said "I don't set the prices, I just schedule tests." She also said she didn't know what the insurance company would pay, but those were the 'asking' rates. She was trying to assure me that no one really pays these rates. I wasn't convinced.

I feel like something is very wrong here. And I suspect it stems from the hospital lobby. Not the one at the entrance to the hospital, either; no-- the one at the entrance to the halls of Congress.

I'm aware, from some prior price-checking on MRIs and other tests (also huge discrepancies, though nothing like the carotid artery ultrasound noted above), that the hospital benefits from some special Congressional legislation [read: SPECIAL INTERESTS] that allows them to recoup extra costs and charge more money for the same services as a non-hospital health-care provider, for some policy reasons that don't quite pass the smell test. And, based on the Camera's recent story about rural hospitals struggling and urban hospitals reporting strong profits, I think the policy should perhaps be tweaked for the rural hospitals, but for the others, it's less clear that the policy should be continued.

Perhaps some healthy competition will change this, but I don't understand it and it doesn't seem right to me. People should definitely be aware of the lower-price options if they (and their doctor) decide such tests will be conducive to their good health---when I think of it---to avoid the possible heart attack they might suffer when they are quoted the hospital's prices!

I know these hospital rates are charged but often negotiated and that those who pay these rates are subsidizing folks who can't pay, but this doesn't seem right if the practice contributes to costs and premiums continually rising; and, more importantly, people should know they have options before they choose to have their tests at the hospital, regardless of whether they are uninsured, have high-deductible insurance or whatever.

Lastly, why is it more democratic for sick people to subsidize poor sick people, rather than having the costs transparent and subsidized by all (i.e., like the la single-payer healthcare systems in Canada and Europe)?