Submitted by Darren Smith, Weekend Contributor
Presenting a succinct short story of a heart attack and the billing as experienced by a patient
One afternoon a man sitting at home and reading a news article, stood up to walk to the kitchen. He felt a sudden pain in his chest along with shortness of breath. About an hour later the pain returned and this time began spreading over the top of his chest and into his neck. Concerned, he drove to the emergency department of a local hospital.
The hospital admitted this patient and did not initially find any signs of heart issues from blood labs and ECG tests but the Hospitalist ordered an overnight stay for observation.
Around 1:30 AM a blood test revealed elevated cardiac enzymes, and again at 6:00 AM. A cardiologist ordered the patient into a cath-lab at 8:00 for an angiogram, concerned of a heart attack.
What follows is one of many true testaments to some health care issues in America.
In the Cath-Lab, the cardiologist found the Right Coronary Artery was 90% blocked and other areas will require further treatment at a later date to allow the heart to recover from the procedure. He placed a stent and the procedure was wrapped up in a little over an hour. The patient stayed overnight and was discharged the next day.
Two days after discharge, the patient felt very weak, short of breath, and angina pains. The on-call cardiologist ordered him to the emergency room. After an overnight stay, the cause was determined to be a drug interaction that lowered his blood pressure to a worryingly low level. The physician changed the drug regime.
In a follow up with the cardiologist, a week later, he recommended based on the continuance of the patient’s angina and general lack of energy that the patient should have the second phase of the stenting move to the soonest date available. On that day the patient went to hospital and another angioplasty was performed. Three medicated stents were placed and another coronary artery was ballooned. The hospital discharged the patient the next day.
The quality of care the patient received was excellent and the staff and physicians performed their duties to the highest standard. The patient is making a strong recovery and is feeling much healthier and better. There was no damage detected to the heart. The intervention certainly prevented a catastrophic heart attack from occurring in the future.
Now for the other aspect of this story: The cost
| 06/19/2014 to | 06/21/2014 |
| Inpatient | HOSPITAL |
| INITIAL OBSERVATION | 231.00 |
| SBSQ HOSPITAL CARE/DAY | 168.00 |
| HOSPITAL DISCHARGE DAY | 169.00 |
| Sub-Total | 568.00 |
| 06/19/2014 to | 06/21/2014 |
| Inpatient | Hospital |
| Cardiology | 45,716.53 |
| EKG/ECG | 640.29 |
| Emergency Room | 2,760.48 |
| Laboratory | 2,367.48 |
| Supplies and Devices | 11,247.60 |
| Pharmacy | 6,304.32 |
| Radiology | 412.26 |
| Room and Board | 3,461.09 |
| Observation Room | 1,053.20 |
| Sub-Total | 73,963.25 |
| 06/22/2014 to | 06/23/2014 |
| Outpatient | HOSPITAL |
| EKG/ECG | 213.43 |
| Emergency Room | 2,760.48 |
| Laboratory | 1,747.63 |
| Pharmacy | 458.67 |
| Radiology | 412.26 |
| Observation Room | 1,579.80 |
| Sub-Total | 7,172.27 |
| 07/14/2014 to | 07/15/2014 |
| Inpatient | HOSPITAL |
| Cardiology | 86,472.79 |
| EKG/ECG | 426.86 |
| Laboratory | 813.78 |
| Supplies and Devices | 56,943.56 |
| Other Imaging Services | 1,019.02 |
| Pharmacy | 9,827.02 |
| Room and Board | 2,633.68 |
| Sub-Total | 158,136.71 |
| Grand Total | $239,840.23 |
The patient spent, in total, seven days in hospital, the cost of which was nearly two hundred and forty thousand dollars. This amount represents 94% of what the patient paid for his house years ago.
When a person wakes up in the morning, they certainly don’t expect to have a mild heart attack or that a month later they will get a bill equal to four and a half years’ income for the median American Household. Yet, it happens quite often in the United States, probably every hour at least.
Fortunately he had health insurance. Of the $239K the hospital, cardiologist, and others billed, the patient was only responsible for $1,824.86. He paid the bill, thankful for this new gift of health and that his insurance indemnified him from the tremendous cost of the procedures.
One certainly cannot stress enough the importance of health insurance, for a healthy life and financial stability. Without insurance or government program most Americans would be bankrupted in receiving treatment as our patient has.
Also, though the treatment was certainly first rate, one has to wonder how seven days of hospitalization and a procedure lasting a little over an hour and the second part three, generated an expense of nearly $240,000.00.
Surely the cost is worthwhile to save a patient’s life. But, what is the cost to society in having a system such as we do presently?
By Darren Smith
Source: Confidential
Photo Credit: J Heuser
The views expressed in this posting are the author’s alone and not those of the blog, the host, or other weekend bloggers. As an open forum, weekend bloggers post independently without pre-approval or review. Content and any displays or art are solely their decision and responsibility.
Don de Drain said:
“I have nothing but contempt for the health insurers I have dealt with. They jerked around the hospitals and doctors whose talents and services saved my life.”
Dear Don:
I happen to share your ire. But just for fun, you might want to ask yourself this question:
If you were a CEO or a board member of what you considered a reputable, ethical, societally-critical insurance company;
And being the reasonably bright, well-informed professional that you are;
How susceptible might YOU be to “jerking hospitals & doctors around” every time you had the chance?
And be sure to take a peek at this vignette – one of about 700 of these recent stories – before you decide on an acceptable degree of pissiness:
http://abcnews.go.com/Health/surgeon-accused-faking-operations-surrenders-medical-license/story?id=20137769
The sad reality is, we are all on the receiving end – at some point – of precisely what we have allowed to fester in our midst.
Dr. Kaplan (plastic surgeon) does a fairly good job here of explaining why hospitals have to charge what they charge. The article is from last year, but still relevant. http://www.multibriefs.com/briefs/exclusive/healthcare_blame_game.html#.U95t1Gd0zIU
My family’s health insurance deductibles went up significantly starting in January 2013. The higher deductibles meant fewer people going to the doctor and fewer patients in the hospital.
http://healthaffairs.org/blog/2013/03/08/decline-in-utilization-rates-signals-a-change-in-the-inpatient-business-model/
It is a vicious cycle for the survival of hospitals. The trend is away from building big hospitals due to overhead costs and more towards telemedicine and ‘house-calls’ with virtual PCPs.
phillyT55 wrote: The ACA does this to some extent, but of course the howling about “illegals” prevented them from attending to that critical issue.
The public has been howling about lots of things such as, to name only a few, NSA spying on Americans, torture of prisoners, police brutality, prosecutorial misconduct, selective prosecution, IRS harassment, all of which are illegal, but, using your logic, the public should just shut up and roll over. Personally, I think anyone who gives refuge to a criminal should be indicted. You start doing that with the folks who harbor and give aid to illegal aliens, and maybe the problem will just go away. What does it say about your judgement, when you are in an overloaded lifeboat howling that there are still more people in the water? Your boat mates would be wise to throw you overboard. This is what it’s coming to, bringing to justice those who are howling to swamp our nation.
leejcaroll, ypu didn’t include how much of the federal code has been overwritten by Executive Order!
The true cost of healthcare Family practitioner tells the reality.
http://youtu.be/r9q1Id41wGo
Darren – thanks for fishing my posts out!
Interesting. Here’s a 2010 article from Forbes indicating that most American hospitals barely break even, but a few have profit margins above 25%. Those are also correlated with higher patient satisfaction.
I think there is a breakdown with the system. If most hospitals are barely breaking even, and are gouging the paying customers to cover the non-paying ones, or those with Medicaid who don’t pay enough to cover costs, then something needs to change. Obamacare pays similar to Medicaid, which pays less than cost, so that doesn’t help.
http://www.forbes.com/2010/08/30/profitable-hospitals-hca-healthcare-business-mayo-clinic.html
Philly – I agree that prices seem to be set by what other hospitals are charging, rather than the actual cost.
“We all know these people are not just sitting around emergency rooms being sick, they are here doing jobs.” Yes. Here is the math. Black youth unemployment is somewhere around 26%. So why do we keep importing more and more people competing for entry level jobs? What does “illegal aliens are working” have to do with whether or not they should enter the country legally? What about the problems I indicated above, in the construction industry, where illegal aliens are rampant, and do unlicensed, uninsured work that is not up to code but they undercut the legal competition?
The relevance of illegal immigration is that one of the excuses for inflating hospital bills is to pay for the crush of people who are uninsured, typically illegal aliens in border states. When I have gone to an ER, whether for myself or others, the vast majority of people waiting did not speak English. So if you have 1 patient paying, and 10 people not paying, they pad the bill.
I support legal immigration, but oppose illegal immigration. But I live in CA, where we often hear about the savage crimes of illegal aliens who did not go through any criminal screening before sneaking across the border. Another problem here is that we are required to carry uninsured driver insurance, because in some areas 90% of accidents are caused by illegal aliens without insurance or ID who just walk away whistling. People who do not live in border states have no idea of the problems caused by a porous border.
Having worked in hospitals for many years in a business (i.e., not clinical), position, I can tell you that that majority of prices/charges are completely arbitrary and have nothing to do with what things cost. Prices are sometimes set by joining a consortium where you get to see what other hospitals are charging and set your prices accordingly. Other charges are set by Medicare and Medicaid– and by the way, these are all available to the public; if you want to see what Medicare would have paid for your bill, which is a good way to begin negotiations, get the CPT and HCPC codes and you can look them up in the CMS.gov website.
For some reason, there was a good deal of discussion about undocumented immigrants and their drain on the system. We all know these people are not just sitting around emergency rooms being sick, they are here doing jobs. The US will NEVER deport these millions of undocumented. Businesses wouldn’t let them. How about instead we get the employers to pay for this care as they should, get these people out of the shadows and treat them like human beings.
The question of whether or not “we” should be paying for healthcare for the poor and undocumented. The FACT is that we all DO pay for their care, we just do a terribly inefficient job of it, and we would be better off getting them primary care, getting them enrolled and preventing the spread of TB and other communicable disease. The ACA does this to some extent, but of course the howling about “illegals” prevented them from attending to that critical issue.
They may bill for these services but they might not get paid that amount by insurance or even the government. I recall a case in Texas where a hospital was going after a patient for the difference….. Even cash payers get discounts…. If there was not so much money in urgent care and heart care facilities…. Do you think they’d be breeding like fracas……
(Darren did my comment go to the spam file? Thanks)
Katen wrote Why is it rude or unreasonable or impossible to expect and require people to follow the law to come here
Why is it rude or unreasonable or impossible Karen to require employers to follow the rules and not hire illegal immigrants?
The jobs wouldn’t go wanting if Americans were wiling to take them. It is 2 sided, maybe part of the reason is because the emlpoyers are not paying a living wage so why take the job while illegals are inline waiting for any job, no matter how low the pay or the hours required.
As for benefits they do not get them willy nilly. (Just part of the link info.)http://aspe.hhs.gov/hsp/immigration/restrictions-sum.shtml
With some exceptions, “Qualified Aliens” entering the country after August 22, 1996, are denied “Federal means-tested public benefits” for their first five years in the U.S. as qualified aliens.
A. SNAP Benefits (formerly Food Stamps)
“Qualified aliens” are ineligible for SNAP for a period of 5 years beginning on the date of an alien’s entry into the United States. (Sec 402 (a))
Exceptions to the 5-year ban on SNAP:
• Children (under 18 years old). (Sec 402(a)(2)(J))
• Aliens who were lawfully residing in the U.S. and were age 65 or older on August 22, 1996. (Sec 402(a)(2)(I))
• Aliens who are receiving assistance for blindness or disability. (Sec 402(a)(2)(F))
• Certain Indians. (Sec 402(a)(2)(G))
• Certain Hmong and Highland Laotians. (Sec 402(a)(2)(K))
• Refugees and Asylees, aliens whose deportation is being withheld, Amerasians, and Cuban/Haitian entrants, and victims of a severe form of trafficking. (Sec 402(a)(2)(A))
• Veterans, members of the military on active duty, and their spouses and unmarried dependent children. (Sec 402(a)(2)(C))
• Legal Permanent Residents who have worked 40 qualifying quarters of coverage. After 12/31/96, no quarter can be considered a “qualifying quarter” if the individual is receiving a “federal means-tested public benefit.” (See Section D below for the definition) Quarters worked by parents when the alien was a child, or by a spouse while married, may be counted by spouses and dependent children as satisfying the 40 quarter requirement. (Sec 402
III. “Federal Public Benefits”
Aliens who are not “qualified aliens” are ineligible for “Federal Public Benefits”.
A. Examples of aliens who are not qualified are:
Non-immigrants (temporary residents) Individuals here on time-limited visas to work, study, or travel. Undocumented immigrants Individuals who entered as temporary residents and overstayed their visas, or are engaged in activities forbidden by their visa, or who entered without a visa. Others Individuals who are given temporary administrative statuses (e.g. stay of deportation, voluntary departure) until they can formalize permanent status, or individuals paroled for less than one year, or individuals under deportation procedures.
B. Definition of “Federal Public Benefit” (Sec 401)
The statute defines a “federal public benefit” as:
• Any grant, contract, loan, professional or commercial license provided by an agency of the United States or by appropriated funds of the United States; and
• Any retirement, welfare, health, disability, public or assisted housing, postsecondary education, food assistance, unemployment benefit, or any other similar benefit for which payments or assistance are provided to an individual, household, or family eligibility unit by the United States or by funds of the United States.
The HHS interpretation of the term “federal public benefit” published in the Federal Register on August 4, 1998 (63 FR 41658 – 41661) states that the following HHS programs meet the definition of “Federal Public Benefits” and are not otherwise excluded. Therefore, non-exempted providers of such benefits (see the exception from verification requirements for non-profit charitable organizations in V below) must verify the citizenship and immigration status of applicants in order to deny federal public benefits to non-qualified aliens.
• Adoption Assistance
• Administration on Developmental Disabilities (ADD) – State Developmental Disabilities Councils (direct services only)
• ADD – Special Projects (direct services only)
• ADD – University Affiliated Programs (clinical disability assessment services only)
• Adult Programs/Payments to Territories
• Agency for Health Care Policy and Research Dissertation Grants
• Child Care and Development Fund
• Clinical Training Grant for Faculty Development in Alcohol & Drug Abuse
• Foster Care
• Health Profession Education and Training Assistance
• Independent Living Program
• Job Opportunities for Low-Income Individuals (JOLI)
• Low Income Home Energy Assistance Program (LIHEAP)
• Medicare (except that an alien who is lawfully present and was authorized to be employed with respect to wages used to establish his or her Medicare Part A entitlement, is eligible for Medicare benefits. For a definition of “lawfully present aliens”, please see 8 CFR 103.12.)
• Medicaid (except assistance for an emergency medical condition)
• Mental Health Clinical Training Grants
• Native Hawaiian Loan Program
• Refugee Cash Assistance
• Refugee Medical Assistance
• Refugee Preventive Health Services Program
• Refugee Social Services Formula Program
• Refugee Social Services Discretionary Program
• Refugee Targeted Assistance Formula Program
• Refugee Targeted Assistance Discretionary Program
• Refugee Unaccompanied Minors Program
• Refugee Voluntary Agency Matching Grant Program
• Repatriation Program
• Residential Energy Assistance Challenge Option (REACH)
• Social Services Block Grant (SSBG)
• State Child Health Insurance Program (CHIP), and
• Temporary Assistance for Needy Families (TANF).
No other HHS programs have been determined to be “federal public benefit” programs.
States can make their own rules
Darren, thanks for this article. I continue to be amazed that we allow what is obviously over-billing by hospitals in these types of services. It has been going on for a long time and I have had both administrators and doctors say that the numbers are inflated due to the way insurance and federal programs work. We have seen costs in our own medical bills for the family that we facially absurd. One doctor told me that it is an effort to internalize the cost for uncompensated care, particularly for undocumented families. However, that still means that the bill is not truly reflective of the real costs for that patient. I am not sure what the answer or cause is. This is an army that is protected by an army of lobbyists in Washington. However, these costs strike me as facially inflated. Thanks for the column and the details.
Jonathan – I remember reading an article some time ago that you can force them to justify each charge and, since you are paying a percentage of the cost, you will lower the cost both for you and the insurance carrier.
Karen S wrote: Oh, and these kids are being shipped as far away as Alaska and Hawaii, twice the distance as a flight home. And their sponsors (usually a relative) get paid up to $7,000/month for housing up to 6 illegal aliens.
After the government no longer can sell securities and raise money to fund public assistance, all those who are dependent upon government checks will resort to crime — tens of millions of them. Once they invade your home and possibly kill a member of your family, or hijack your vehicle, you’ll forever regret having supported illegal immigration. And if you have been behind gun control, you’ll regret that even more.
Help! Lost a second post!
Karen – this will not make you feel any better, but I had eight in a row that were eaten. Very frustrating.
According to the DEA, Mexican Drug Cartels are the most serious threat from organized crime. And they have spread beyond the border states. While border patrol agents have been pulled off post to deal with the self-inflicted crisis of the illegal immigrant surge, the cartels exploit the weakened security.
http://www.usatoday.com/story/news/nation/2013/04/01/mexican-drug-cartels-moving-into-usa/2042345/
Karen, I retrieved your comment at 8:49.
Anther problem in my border state of CA are the Mexican gangs, sex traffickers, and drug cartels like Sinaloa. It’s foolish in the extreme not to force people to go through the legal immigration process and screen them for criminal backgrounds:
http://voxxi.com/2014/03/27/drug-violence-california-mexican-cartels/
For people who live in non-border states who clamor for open borders, it’s not just the border states’ problem anymore. These savage cartels and gangs are branching out across the nation now. Maybe minds will change when it’s it everyone’s backyard.
From the IG report:
“UAC and family unit illnesses and unfamiliarity with bathroom facilities resulted in unsanitary conditions and exposure to human waste in some holding facilities.”
Isn’t that nice?
Thanks, Darren. Your assistance — and posts — always appreciated.
If my post can be found, it explains that the comments about the diseases among the illegal immigrant unaccompanied children, which spread to border agents’ children, came from an IG report from the Department of Homeland Security.
Oh, and these kids are being shipped as far away as Alaska and Hawaii, twice the distance as a flight home. And their sponsors (usually a relative) get paid up to $7,000/month for housing up to 6 illegal aliens.
Madness.