As we move forward with healthcare reform, I hope we don’t sell our values down the drain in the name of making “hard choices in order to survive.”
Healthcare is a business but it is a business that must be based on a strong moral center and led by executives with a never failing commitment to do the right thing.
In recent weeks, news reports concerning exorbitant fees for out of network surgical assistants and emergency room doctors have cast a negative light on doctors and the hospitals where they practice.
When a surgeon can charge an assistant’s fee that is more than 30 to 40 percent higher than the lead doctor on the case, and the insurance pays 100 percent, you have to stop and ask, is that ethical? This was reported in a newspaper recently and the patient was angry, not only because his insurance carrier had to pay an extra $117,000 bill to a physician he’d never met, but because in making financial preparations for the surgery, no one told him there would be another doctor with a monster fee that had no basis in value. When pressed by the insurance company to send their 100 percent reimbursement on to the doctor who assisted, and was threatened by said doctor with a lawsuit if he did not forward the check, the exasperated patient told the reporter with words to the effect, no wonder healthcare costs are so high, no one wonder people are losing confidence in the process.
In another story, a mother whose daughter cut her hand, did some quick research before rushing to the emergency department of a nearby hospital. She wanted to be sure the hospital was in network because she could not afford any big financial surprises. But weeks later she received a bill from the ER physicians group for more than $4,000. Her insurance company reimbursed the doctor less than $400. She was told that she had to pay the medical group the balance. Why? No one had told her that the doctors were not in network, nor was there a sign at the hospital’s registration desk.
She felt duped.
The ED group countered the PR fuss with an explanation that because insurance companies arbitrarily pay emergency room physicians less than the value of their care, they rarely sign contracts so, in effect, all patients are out of network.
Emergency room physicians have the right to make a decent living. I doubt that anyone is challenging that important principle. Most reasonable people would also agree that if the insurance companies refuse to offer pay at a rate that more appropriately reimburses the ER physicians, that they should have the right to refuse the contract.
The problem with the two cases reported above is that there was a total breakdown in transparency. It was probably intentional. I have a strong suspicion that money got in the way of doing the right thing. Was it right, was it ethical, not to disclose that information to the patients? I believe the answer was no.
If you want more healthcare regulation, then those two examples, if widespread, will certainly invite a level of scrutiny and probably an eruption of new regulations that will only make matters worse.