Category: Health Alerts

Who is to Blame for Out-of-Network Balance Billing?

Hospitals increasingly outsource their emergency departments to emergency medicine staffing agencies. However, emergency staffing is different than temp agencies supplying nurses, physical therapists or radiology techs to meet staffing needs that vary one day to the next. Emergency Room (ER) physicians generate revenue for the hospital and also bill for their own services provided to patients in the ER. A National Bureau of Economic Research study explains why this is sometimes controversial. Using data from a large national insurer, the study finds the average charges billed to patients often  rises after an outside agency takes over staffing for the ER. In many cases, hospital admissions rise, as does up-coding charges to higher-paying codes.

After an emergency medicine agency takes over hospitals often enjoy higher fees and less hassle over staffing. However, patients complain outrageous fees, inflated bills and out-of-network balance billing that catches them by surprise. Complaints are streaming in across the country about high balances owed to out-of-network emergency physician even though patients made sure the hospital was in their network.

There is no easy way to ensure physicians who provide services at the hospital are in-network. Why would hospitals not require physicians staffing their ERs to affiliate with area insurers? Perhaps there’s an unstated agreement; the staffing firm games the system and refuses to join networks and the hospital allows the game to go on since it’s benefiting from increased revenue.

There are two opposing views on why physicians staffing hospital emergency rooms sometime refuse to affiliation with area insurers. Doctors complain insurers low-ball them with paltry reimbursement offers that are below market. Insurers argue emergency room staffing agencies take advantage of patients who are in no position to go elsewhere even though the prices are high. (In reality, the prices are unknown)

For some emergency room physicians joining a network would likely yield lower fees, since their patients cannot easily go elsewhere. Physicians who have not contracted with patients’ health plans are free to charge whatever they want. If the insurer doesn’t pay, the physician can often bill the patient for the inflated balance. One researcher compared this to kind of ambushing patients. It is no coincidence that out-of-network balance billing is more common among physician specialties whose members rarely meet with patients prior to providing care. These include radiology, pathology and anesthesiologists – and of course emergency physicians. Sometimes assistant surgeons are placed in this category.

Across the country more states are taking steps to limit patients’ exposure to surprise out-of-network bills. One solution is to require a “meeting of the minds” between doctor(s) and patients or hospitals and patients before a debt is collectable. A meeting of the minds is already the standard under contract law.

Devon Herrick, PhD, is a health economist and former hospital accountant.


Coming Changes in the Way Medical Debt is Reported

The three major credit reporting agencies have announced major changes in the way medical debt is reported. STAT News reports that about half of all bad debt on credit reports is related to medical bills. Starting in mid-September, Experian, Equifax and TransUnion will all initiate a 180 day waiting period before reporting medical debt on consumers’ credit reports.  This will allow six months for hospitals, clinics and doctors to work out medical bill payment disputes with insurers and patients.

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Report: Hospitals Who Want to Collect Fees should Provide Better Cost Estimates

Hand Holding Cash ca. 1998

Historically hospitals have not really had to worry about collect directly from patients. On average patient cost-sharing is only about 3% when patients enter the hospital. Health care providers generally focus on insurance reimbursement. Maybe that is changing with the growing prevalence of high deductible plans. Now hospital patients can potentially owe several thousand dollars depending on whether they’ve met their deductibles and their cost-sharing arrangements.

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Senate Better Care Act: A Big Bunch of Sausage Meat Loaf

Backroom policy deals have been described as akin to making sausage. You don’t really want to see it done or you’d lose your appetite. The new senate health bill is more like meat loaf than sausage, however. By that I mean a recipe composed of delicious ingredients mushed together with really distasteful ones in an unappetizing blob that could have been a great burger but wasn’t. Remember that 1977 song “Two Out of Three Ain’t Bad” by the band Meat Loaf? That pretty much sums up the senate health reform bill.

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The Silly Appeal of Expanding Medicaid for All

DocsMeanMany people believe Obamacare was a conspiracy, with asinine design features intended to cause the program to fail. The primary goal in the minds of conspiracy buffs’ was to usher in a single-payer program of Medicare for All once Obamacare collapsed under adverse selection. The theory goes something like this: with nowhere to turn except the government, Americans would finally throw up their hands and acquiesce to government intervention. Seniors purportedly all love their Medicare, so why not expand the program to cover even more people?

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The Opioid Crisis Obeys the Law of Unintended Consequences

Capture71A letter to the editor of the New England Journal of Medicine back in 1980 is thought to have been the nudge that set the opioid crisis in motion. The letter claimed only four addictions were documented out of nearly 40,000 patients who were prescribed powerful opioid pain pills. The article arguing addiction to prescription opioids is rare has been cited 600 times — often incorrectly.  Doctors and drug makers used this as evidence that it was safe to prescribed opioids to more patients with chronic pain.

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Socialized Medicine Goes by Many Names: Budget Buster is But One

DocsMeanMembers of Congress — both Democrats and Republicans — are being asked if various health care proposals they support provide so-called “universal coverage.” Socialized medicine goes by many names: Universal Coverage, Coverage-for-All, Medicare-for-All, Medicaid Expansion and Single-Payer are ones you’ve probably heard of. Perhaps you don’t really understand what all these altruistic-sounding phrases imply. Here’s a dirty little secret: you’re not supposed to know. The average American with good employee health insurance already pays for coverage (albeit indirectly) in addition to a Social Security payroll tax surpassing 15 percent. Most Americans would balk once they discovered the ugly truth: universal coverage requires a near doubling of payroll taxes. A case in point is California, New York State, Vermont and Colorado.

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Drain the Health Care Swamp that’s Awash in Other Peoples’ Money

Caduceus with First-aid Kit --- Image by © Royalty-Free/Corbis

Caduceus with First-aid Kit — Image by © Royalty-Free/Corbis

The 2017 winner of the Miss USA pageant ignited a firestorm on Twitter when she opined that nobody is entitled to thousands of dollars worth of free goods and services which they did not earn. The tempest in a teapot resulted when Kára McCullough said health care is a privilege, not a right. Her answer was far from perfect; she mentioned that to have health coverage you need to work.

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How Technology & Health Care Systems Impact the Cost of Healthcare

stethoscope-on-moneyThe United States spends about $3 trillion on health care annually, nearly $10,000 per capita — accounting for about 18 percent of gross domestic product. Medical technology is costly, but it is not the only reason medicine is expensive. A variety of factors are to blame for what makes health care expensive in this country and abroad.

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Interactive Group Therapy in the Information Age

Laptop and Stethoscope --- Image by © Royalty-Free/Corbis

Laptop and Stethoscope — Image by © Royalty-Free/Corbis

Imagine attending private lectures and taking all your college exams in your professors’ offices individually, one-on-one. Your instructors lecture you, then pepper you with questions, grading your answers and recording your scores. This is not unlike traditional physician visits. Contrast this to attending classroom lectures and taking online multiple choice exams where a computer algorithm tallies your answers and calculates your grade. Classroom instruction with standardized testing is much more efficient that private tutoring. Hundreds of people can learn and take their online exams simultaneously. What if medical productivity could be similarly improved?

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