Inside ‘Bitter Pill': Steven Brill Discusses His TIME Cover Story

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Simple lab work done during a few days in the hospital can cost more than a car. A trip to the emergency room for chest pains that turn out to be indigestion brings a bill that can exceed the price of a semester at college. When we debate health care policy in America, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

Steven Brill spent seven months analyzing hundreds of bill from hospitals, doctors, and drug companies and medical equipment manufacturers to find out who is setting such high prices and pocketing the biggest profits. What he discovered, outlined in detail in the cover story of the new issue of TIME, will radically change the way you think about our medical institutions:

· Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer—Medicare—from even trying to negotiate the price of drugs.

· Tax-exempt “nonprofit” hospitals are the most profitable businesses and largest employers in their regions, often presided over by the most richly compensated executives.

· Cancer treatment—at some of the most renowned centers such as Sloan-Kettering and M.D. Anderson—has some of the industry’s highest profit margins. Cancer drugs in particular are hugely profitable. For example, Sloan-Kettering charges $4615 for a immune-deficiency drug named Flebogamma. Medicare cuts Sloan-Kettering’s charge to $2123, still way above what the hospital paid for it, an estimated $1400.

· Patients can hire medical billing advocates who help people read their bills and try to reduce them. “The hospitals all know the bills are fiction, or at least only a place to start the discussion, so you bargain with them,” says Katalin Goencz, a former appeals coordinator in a hospital billing department who now works as an advocate in Stamford, CT.

Brill concludes:

The health care market is not a market at all. It’s a crapshoot. Everyone fares differently based on circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or protected only partially by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow knew the prices before they got billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a sellers’ market where the only consistent fact is the profit of the sellers.

Read the full TIME cover story on rising medical costs here.

276 comments
AnnStanton
AnnStanton

Try reviewing 1500 pages of itemized statements that cover a nine month period.  This is what was involved prior to my sister's death and the prices were staggering.  Strange to me however that payments were higher for long term acute care hospitals, rehab hospitals, and the nursing home in Pittsburgh where she was injured or developed additional medical problems before returning to the UPMC acute care hospital in between each.  Four specialty hospitals and a nursing home for rehab and wound care and she ended up  in a hypoglycemic coma, respiratory arrest and an anoxic brain injury. She was kept alive on life support while remaining unresponsive because a nurse at the nursing home refusd to give her a doctor-ordered medication and then went on to falsify the medical record.  Neither the PA Health Dept nor Medicare have any problem with falsifying medical records and causing injuries and death by their neglect and abuse of the patient.  I've been at this for over a year and I'm beginning to see that government is a major problem in this health care problem because they just refuse to do their jobs properly and tell these medical facilities that they can do whatever they want with no penalties involved.

RalphBeckett
RalphBeckett

In response to the post by KristaCantrellBrennan.  I don't think your problem is uncommon.  A neighbor recently had a hand prosthesis repaired -- it was small and needed a minor adjustment.  He was told it would be minor and did not ask the cost.  Later a 30 min job was billed at $600. And, just like you he was stuck with the cost that insurance would not pay.  One expects professionalism not exploitation.  I personally will be asking for a "not to exceed" estimate in the future -- no estimate, no deal.  Or, find a nurse that wants some well reimbursed part time work!

KristaCantrellBrennan
KristaCantrellBrennan

I was recently in the Christiana care hospital outside of Wilmington Delaware. I was there for outpatient services Specifically infusion. The market cost of my medication was approximately $1500 a month. At present because it's a financial burden, the pharmaceutical company gave me the free prescription. I love the hospital had to do was infuse the drug in the infusion center. I was there for two hours. I received a bill for $14,000. My Horrible insurance didn't cover the cost of the infusion, however, my drug was covered by the pharmaceutical company.

How does two hours of infusion cost $14,000?

I go to a small compounding pharmacy/infusion center now. My infusion is $125 cash.

$14,000? Christiana care? When I called to inquire about the bill and stated that it Must be an error, They said it was the cost. How is this possible? Now I am stuck with the medical bill I certainly can't pay.... And will have this medical cost Appear on my credit report.... It makes me look like a deadbeat. I didn't invent this fictitious charge. The hospital did. Other professionals in the infusion industry tell me that the approximate cost for infusion in the hospital is about $1500, Which is outrageous but Is more appropriate than $14,000. Even if they provided the drug, the cost would still only have been about $3000. Who takes responsibility to make sure patients are not Ridiculously overcharged? Is Obama care going to fix this? I'd love to be optimistic… But I'm pretty sure it won't.

RonnaRubin
RonnaRubin

Thank-you Steven Brill for your article! I fainted in a restaurant and was taken to a hospital ER by ambulance which I declined.  The 2 mile "fully loaded" ride cost $1725.00.  I arrived with all normal vitals and the lightheadedness had subsided. I declined all treatment in the ER but somehow got saddled with $825 ER bill and $100 Dr. exam.  Because I was able to reference your artice and threaten to go to the news media with my story they are now finally reviewing my bill and yes the computer generated a list of 12 tests they wanted to perform. The staff harressed me for 90 minutes to have these tests....they finally let me sign AMA papers.  This still may go to collections but I am hoping your article has some clout.

monastev
monastev

I cannot thank Time and Steven Brill enough for lifting the veil of secrecy on hospital billings.  No wonder people fear going into a hospital.  You can become saddled with crushing debt and bankrupted.  We need  some whistleblower insurance coders to come forward and shed more light on the chargemaster.  Thanks for starting a national conversation.

mkb
mkb

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Medical field concentrates on more acute problems facing the society. there lots of tests to assess the functional activities of Heart, lungs, kidney, about Diabetes or hypertension. there are very few tests to assess the functional level of Muscles and bones even they are very rarely used.

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PatriciaMcardle
PatriciaMcardle

Dear Mr. Brill, 

Thank you for your excellent, clear, insightful and incredibly important story.  It should have prompted hearings in congress, headlines around the country and mass protests in front of hospitals.  Sadly, I fear that many Americans (employed and unemployed) are so beaten down by the economy, the endless political infighting of our elected officials and the basic struggle to pay the bills, that those who need this reform most will do nothing and those who need reforming most will carry on with business as usual until sometime in the future there is a crisis of epic proportions that forces reform in our unfair and inefficient health care system.  You have done a great service for us all.  

MedicareMaven
MedicareMaven

In 2011, Sloan Kettering did in fact receive an average of $2,298 per claim for Flebogamma injection.  They were paid $35 per unit and each claim (patient encounter) averaged 65.5 units each.  Each unit is 500 ml.  This data is from Medicare's outpatient files.  Wannabecoder may be thinking about physician payment, not hospital outpatient payment.  Mr. Brill's data was pretty darn close. If you look at Medicare outpatient payments to hospitals in 2011, Sloan Kettering is #1 and MD Anderson is #2.  

adamstaffordsantafe
adamstaffordsantafe

Dear Mr Brill.  

In your recent article you have referenced operating profit as excluding depreciation.  Though this is a favorite and common "yardstick" measure of operating profitability, or as I would rather say, "viability" in the non-profit world, excluding depreciation expense from operating profit is an internal measure by which companies and organizations measure executive performance.  When one discounts depreciation from the calculated operating "profit" of any enterprise it must be realized that the measure effectively says, "Let's ignore all of the capex it took to get to the operational status we have at the current time."  The assumption, when evaluating executive performance and excluding depreciation, is that capex is a necessary expenditure for the on-going viability of the enterprise, or, pursuit of the mission of the organization, and hence, ought not be included in the calculation of an executive's operational performance, because the expenditure would have had to have been made in order to remain competitive, regardless of those steering the ship.

That being said, ignoring capex (ie depreciation) in your calculation of profitability is most likely somewhat, if not grossly, misleading and unjust. If doctors were able to perform their duties without hospitals, tools, hospital beds or the like, then your calculation is sound.  However, in a world where medicine is preferred to be practiced indoors and in a sanitary environment, your allegations are both unfounded and uninformed.  Please let me know if you disagree.

garagebrew
garagebrew

I would like to see one change in health care that I think would change the face  and costs of health care overnight. I would like to see legislation that would require the free market practice of up-front pricing or a good faith estimate for all non-emergency health care procedures that require a pre-determined appointment. This would mean the consumer would know the price up front prior to office visit, procedure, test, evaluation, rehab, etc...

You cannot have a free market if no ones the costs!!

PaulTDavis
PaulTDavis

So where are the plaintiff attorneys? This sounds like the mother of all class action suits to me!


I am a retired physician and this seems like an example of why the legal profession was created. Is price gouging of such magnitude legal in this country under existing laws?

WannabeCoder
WannabeCoder

I'm very curious as to how Mr. Brill determined Medicare would reimburse Sloan-Kettering $2,123 per treatment for Flebogamma.  According to CMS, current maximum payment limits for the drug are just shy of $35 for 500mg (source: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/Downloads/January2013_ASP_Pricing_File-12-06-2012-.zip, cell D198), and the maximum vial size is 20g.  This would result in a capped Medicare Part B reimbursement of $1,400 per vial - suspiciously close to the doctor's guess as to its cost.

Further, the $1,650 price the other two hospitals quoted is barely under that vial's Wholesale Acquisition Cost, or WAC, of $1,653.20.  WAC acts as the manufacturer's "ceiling" price. Manufacturers sell product at prices exceeding this level only in exceedingly rare circumstances.

The allegation that Grifols is manipulating their reported Average Sales Price to drive product utilization is an extremely serious charge.  Massive fines, jailtime for pricing analysts, managers, and corporate executives found guilty of such a charge would be both expected and welcomed if it were true.  However, it appears that Mr. Brill is the one who has been misreporting the data.  Whether this is due to ignorance or malevolence is uncertain, but neither bodes well for this piece and the periodical that published it.

GJGUSTAS
GJGUSTAS

Unbelievably, The Chargemaster price list is a key tool in keeping nonprofit hospitals tax-exempt under current IRS regulations, which require them to have a primarily charitable function.. Hospital's treat discounts given against the chargemaster prices to Insurers, Medicare , Medicaid and individuals as free care justifying their charitable existence.

Result is that hospitals like UPMC in Pittsburgh, shown in your article as being the most profitable of the nonprofits, being able to brag of their $500 million of free care given, while still generating a surplus of over $500 million.

hag2hag2hag2
hag2hag2hag2

Health care in America remains the only industry in the world which fails to compete capitalistically based on the quality of a product.  Medical, surgical and preventative outcomes are the only products produced by health care.

After 40 years of market and medical failure, America needs to cut out the taxpayer subsidized middle man insurance industry and move to single-payer national health insurance for all Americans with private doctors, hospitals, clinics, therapists and drug companies competing capitalistically based on the quality and pricing of medical, surgical and preventive outcomes.

Goldhar625
Goldhar625

This Article is a great example of the kind of in depth journalism that a 'real' Magazine/Publisher can/should support.  My thanks to Time for making it possible. Every Member of Congress and all the State Legislatures should be required to read this article and take a test on their ability to comprehend its meaning.


We don't need 'single payer' Health Care/Insurance - we need 'SINGLE PRICE' health care and more competition based upon price.  Publishing costs and prices for all Hospitals and Medical practices would be a good beginning.


We, or the IRS, should also look carefully at the so called 'Non-Profit' sector 'Surplus' and salaries.  Is any Hospital or University or other Charity, or Faith Based Organization really 5 to 20 times more complex than a Cabinet Office. If so, they are too big and need to be broken up to get closer to their 'clients'. 

 Any non-profit that can afford to pay its President over $500,000 per year; can afford to pay local property and sales taxes.  IRS needs to set a cap on the salaries paid at any and all '501c3'  organizations.  State Legislatures can do the same for state/local supported Universities and other 'charitable' institutions that can receive tax free donations.

Vunglay
Vunglay

Read this stories that why I want the Universal Healthcare for all at least or I want this country run by Socialist like as some Europe countries

False_Believer
False_Believer

Interesting: the medical establishment really hated it when someone published a recent study suggesting that being slightly overweight was associated with a longer life. The reaction went far beyond scientific disagreement. Some of the comments here suggest another motive: it undermines the lobbyists' "blame the victim" argument for overcharging patients. Follow the money indeed.

BobBu
BobBu

RE: origin of "Chargemaster"   I am a retired surgeon.  In the early 1970s "price fixing" was a major concern.    Physicians were then, and are now, instructed by Medicare that they must have their own independant fee schedule covering all services; those fees cannot, like the Academy's booklet, be discussed with other physicians since that would be "price fixing."  In the late 1980s, early 1990s, management consultants and the word on the street was that a physician should set his/her fee higher than the most generous insurance contract allowed so recoverable charges would be not be lost.  Thus came about the outrageous fee schedules doctors  (like the hospital chargemaster) maintain.  I retired the first time in 1995 in protest. 

Many are complacent.  Insurance companies are intimately involved in setting prices and fees.  Higher charges by providers = more profits for insurance companies.  Physicians are seduced by the high payments the insurance companies pay to keep them quiet.  

madashell
madashell

Where was this type of in depth reporting BEFORE the so called 'Affordable Care Act' ? Seriously, Mr. Brill - this is a great article...informative and in depth for consumption by the public consumer at the bottom of this pyramid, but why just now in Feb. 2013?

KennethOssman
KennethOssman

When getting medical care why can't we bring our own "negotiable" contract with us?  For instance:  I, the patient, will volunatily pay the rates paid by medicare plus a maximum of 10% markup for any proceedure, supplies, drugs or services I receive.

edshapiro
edshapiro

The most depressing thing is that Brill thinks reform will never happen because the lobbies and their respective communities of health care workers (from Hospital CEOS to doctors , nurses, orderlies, maintanence  folks, etc) have an all too human vested interest in stopping it...GREED at our expense. That said, many of these folks are calling into talk shows, etc. in total agreement with Brill .Efforts at reform will be a battle royal. This is the next real battle to reduce health care costs. Obamacare barely touches the surface. I agree with Brill's statement, "The problem boils down to one main thing:The federal government does not regulate the prices that health-care providers can charge."  If there is a polititian out there right, left, or in the middle  that supports what brill has to say and will take a stand, introduce a bill, i will support that person with everything I have.

therealdeal
therealdeal

Perhaps instead of just making comments about pricing, some real research should be done to see the reasons behind the pricing.  So many people think this way, but the truth is no one researches why.  Do you realize the cost of providing 24 hour service.  When you want the hospital there it is great, but you don't want to consider the real issues behind pricing.  As for medicare, they do not even cover the cost of the actual service.  I work for a hosptial the is 50% Medicare and if we had to rely on them alone, we too would be closing our doors like many other hospitals.  Maybe that should be taken into account also.  How many hospitals have closed because they just can't afford to stay open. Is that what you want?  What will happen when you are in a ER situation and need us.  Is is so sickening people like this who just make these kind of statements without really researching the issue.  What kine of journalism is this? 

ajamaldr
ajamaldr

part  b

Marketing of services should be abolished - marketing is a sign of profiting. Have one flat non negotiable price for services - ie create price benchmarks. This wil eliminate third part payers, and business managers (and haggling). CEO and management role should be redefined. Do not use management to manage business aka as revenue generation or to seek revenue opportunities. Hospitals will then grow on a need basis and not competitively and will have to forsake gimmicks and unnecessary equipment purchases to leverage their markets. 90% of equipment is discarded while at 40-50% useful life. One of the biggest gutters where money is wasted and corporate greed of equipment manufacturers gouges out the money. Keep a close eye on disposable equipments - massive wastages there too.

The government needs to take a big stake in generic drug industry and create a trure non profit generic drug industry.

I am a part of an enterprise which is trying to do all the above in Pakistan. www.helpus.pk

ajamaldr
ajamaldr

I am a surgeon and practiced and trained in the US for 13 years before moving back to Pakistan. I am now witness to 2 corrupt healthcare systems and can suggest some remedies.

Healthcare is like firefighting and disaster management - not an industry with business opportunities (ie  people in trouble) but a place where people are taken care of to help them get through their personal calamities. The providers are people who are only in the business of caring and make their livelihood thus. Not a place where infrastructure and usables (drugs and disposables - D and Ds) are sold for profit or built on patient revenues. The infrastructure is created as a collective insurance paid for by the society and government and not by the stricken only.

Non profit should be defined as patient revenues not used for infrastructure, growth and expansion and any surpluses used to create patient endowments, reduce prices or salary raises to the medical workers.

Continued as part B....

greedydoc
greedydoc

I am a radiologist.  Been a radiologist for 2 years.  I've been disgusted by what I've seen since I've been in private practice.  A radiologist is a MD with 5-6 years of training after medical school which is equivalent to most surgical fields and subspecialties (cardiology, orthopedic surgery, etc.)  All radiologists, like most doctors, are mainly in it for the money.  Currently radiologists make 400 to 500K a year.  They used to command 700K a decade ago.  We read MRI's, CT's, PET scans, mammograms, ultrasounds, xrays, and nuclear medicine studies.  The most unethical things about what we do is the volume of studies we read and the speed at which we read studies.  Our number one goal is to crank out as many reports as possible so we can maximize our salary.  We get paid per study.  For example we get $75 for a MRI.  We get $30 for a mammogram.  A radiologist will try to read 40-50 MRI's in a day.  They will try to read 100 mammograms in day.  On saturday call we read over 200 studies.  Because of the speed and overwork the quality goes down and lots of mistakes happen.  I've seen ridiculous life threatening mistakes that a first year resident wouldn't miss but radologists with years of training miss because they are going to fast.  Obvious tumors, perforated bowel, fractures, all missed because going too fast.  Partners cover for each other and don't mention that the mass was their on the prior study.  Does anyone worry that the volume is too high, that it overworks the radiologist, that it is not in the interest of the patient?  No.   Lowering the volume means less of a salary.  And that is the number one motivation.  Maximize salary. Try not to hurt too many people.  Instead of "do no harm."

Surgeons can't go too fast because they will kill someone on the table.  Internists/family doctors need to go fast to maintain their $150K salaries... plus they can always order a scan or send to a subspecialist.  Subspecialists like radiology have no excuse.  They could easily cool it down a bit and make a little less money per radiologist and do a better job, but they refuse.  They want to maximize salary.  It is a prime example of what is wrong with fee for service.  I see and do it everyday

Right now an ethical radiologist who is willing to take a lower salary, who wants to take his time and do higher quality work can not get a job.  No group will hire a guy who reads "slow".   Productivity is constantly monitored.  The group actually likes you more if you read more studies and bring in more money rather than if you read more accurately and give better reads.  God forbid if  a radiologist only made 300K and provided better results for their patients.

Comments?




esraaa21
esraaa21

@memetsimsek allah bunca öğretmen ataması isteyenler ve ailelerinin ettiği beddualardan sizi korusun

BobBu
BobBu

What I tried to point out in my post 3/1 re: origin of Chargemaster is that they whole idea of competition is a hoax.  There is none.  Every provider/supplier (hospital, physician) is required to have a separate list of charges, giving the impression that there is a free market, but the only thing that matters is what the payor is willing to pay (payor is not the comsumer).  Medicare fixes a specific price allowable for each service; Private ins. Co. are willing to pay about 110 to 120% of what Medicare has determined the price to be.   The Chargemaster is thrown aside, unless the patient is not protected by a contractural agreement (insurance).  Any competition between private companies is lost in the complexity of the system.  SNAFU   

CerebralSmartie
CerebralSmartie

@BobBu This post was incredible. You retired in protest, wow! What integrity. It would be wonderful if you could be part of reform initiatives. 

YVRView
YVRView

@KennethOssman  

The negotiable contract might  work provided that there is (1) clear understanding of what medicare pays for specific procedures etc, and (2) willingness of the medical service provider(s) to accept such contract. When tried in the past, I was told by the service provider that the insurance companies audit  provider's billing records to assure that the un-insureds do not get equal or better rates. Another response was that the compensation from insurances are so low that the additional revenue at full charge is needed (this response appears to be untrue, since revenue drawn from the un-insureds will be a very small portion of the total revenue).

TingLiu
TingLiu

Agreed about the depressing reality. The greedy healthcare system can not be fixed util the greedy politicians stop their corruption. Obamacare just helps another greedy business - insurance.

AnthonyMcMillan
AnthonyMcMillan

So your saying that a hosptial cant stay open if they rely on medicare, even though medicare is paying twice the cost of anything the hospital is having to pay out? I would love to work in a business where they profit margin was a hundred percent on "anything" I was selling. I do understand with a service industry like a hosptial costs would be greater, however it seems there are more then a few hosptials that have closed merely out of greed or poor management, perhaps your institution suffers from the same situation. Either way Americans pay much more for healthcare then any other country in the world, yet the "quality of service" is below that of Cuba, how is that possible? We are ranked like 38th in the world when it comes to quality of care. If we pay the most in the world, shouldnt we getting the best care in the world? There is a obvious disconnect in the healthcare industry and it needs to be addressed.

ajamaldr
ajamaldr

@therealdeal I think if hospitals reduce their overheads by not having a competitive relationship with other hospitals and actually trying to get mileage out of their equipment, they will get rid of a lot of dead weight like CEOs/CFOs, marketing department and business managers and massively reduce overheads. I am in Pakistan and use the hand me downs from USA an do at least a fair job by US standards. My operating cost is a whopping 5% of the US costs. Notwithstanding the salares which are much lower, the real savings are in drug pricing and equipment.

seejayjames
seejayjames

@therealdeal  How do you explain the dozens of single-payer countries who provide comparable services for a fraction of the cost? Doctors and hospital workers are generally well-paid there, though not exorbitantly. The difference? No price-gouging on drugs, tests, and equipment, and no filthy-rich hospital or insurance-company CEO's. Prices are well-regulated and bear at least SOME resemblance to the services provided and the equipment used. Prices here are beyond absurd, which is abundantly clear in the article.


Not to mention the ridiculous number of times hospitals in the US double or even triple-charge people for dozens of things on a bill, only to take them off the bill IF the patients and/or advocates raise a stink about it. Tell me ANY other business or industry who does this and gets away with it. I call double-charging FRAUD--what else could it be?--and it should be prosecuted as such.

teri
teri

@therealdeal Apparently you did not read the entire article nor vet any of the information in the article. And YOU obviously did not do any of the research you call for. The majority of hospitals make huge profits with highly paid executives and charge prices for supplies and services that are not remotedly based on their actual costs. I am  not  suggesting  hospitals, labs, and drug companies should not make a profit -- but in many/most cases the profits made border on the criminal. If you do not believe what is written here do your own research, it is information that is available to anyone willing to do the work. The Medicare system is not ideal but actually gets a bad rap as they at least attempt to bargain with hospitals in order to pay somewhat closer to realistic prices for services rendered. For the most part we as consumers are held hostages by the medical establishment...

Afrozemerchant
Afrozemerchant

@therealdeal you must be a doctor or somebody associated with health industry,I don't blame you for this comment,you care for yourself than any body else.

juliannesherrod
juliannesherrod

@therealdeal Have you read the article? Mr Brill's article is nearly 30 pages long and lists the many many factors that lead to these prices, which have no bearing in reality. I suggest you read it in its entirety. Do you think pricing something like cotton bandages at $77 is fair to the patient or to their insurer (if they even have one). I fully acknowledge that 24 hour care is expensive, but the patient should not be paying exorbitant prices for medical supplies (on top of hospital 'facility' fees which are supposed to cover things like bandages and aspirin) that they can pick up for pennies on the dollar at Walgreens. Furthermore, this model preys upon the people who can afford it least-those without insurance or Medicare are subject to the Chargemaster fees, which are not based in the reality of What Things Cost. Go ahead and provide a healthy mark up to be sure the hospitals can make a profit, but does that mark up need to be 10 times the original cost?

McFeist
McFeist

@greedydoc I am a medical transcriptionist.  I no longer transcribe radiology (mainly due to the advent of technology and radiologists generating their own reports), but the mistakes I heard dictated on a regular basis would make your skin crawl, which I assume was from the radiologist being in a rush and not paying attention to what he/she was saying.  Many, many, many times I would hear right and left mixed up in reports, I would say on a daily basis.  Slow down, pay attention, a patient' life may be at stake - or at least her breast or other body part, especially since you might be generating your own reports now and may no longer have that "extra set of ears." 

seejayjames
seejayjames

@greedydoc  +1 on sharing the information. I can see how the fee-for-service idea is all too tempting for people to abuse. Doctors (and/or pharmaceutical companies and/or medical equipment manufacturers) profit while the patients get overcharged and receive poor-quality service and diagnoses. These can be life-threatening, and even if they're not, they are hugely expensive...there's no excuse for rushing to make a buck (or a thousand).


I'd like to see a comparison of a typical fee-for-service hospital and the Cleveland Clinic, which is salary-based. As I understand it, doctors there can make lots and lots of money if they have lots of experience and their performance outcomes (quality not quantity) is good. I think a set salary is a far better idea...no incentive to order extraneous tests, and you're expected to take your time with your diagnoses. For the prices that US hospitals charge for diagnoses, they should be the best in the world...and apparently, they are far from it.


There's a reason we have restrictions on the number of hours that people can work in certain jobs...fatigue can be dangerous for pilots, bus drivers, train operators...but doctors? Is there a limit there? That's another worrisome angle, because doing a few extra hours can mean a lot more money, even when the doctor is exhausted and shouldn't be working.


Thanks again for the info...the story just keeps getting more maddening...

ChristinaMarieChapman
ChristinaMarieChapman

@greedydoc That is a fantastic and very revealing comment. Thank you for doing the right thing and sharing this information. You should contact the press with this information as well, although I understand if you would choose not to do so, since your career could be put at risk. What a sad, sad system we have invented in this country.

likewatermusik
likewatermusik

Completely agree with you.  I've worked in a tranplantation laboratory in one of the premier hospitals in the world and am amazed at all the waste that occurs especially from the physicians and nurses. In many cases, they still do not know what certain tests actually do and order extra tests even when the other medical data suggests otherwise. "Better safe than sorry" mentality is helping kill this country. I am a moderate with liberal leanings but still was frustrated that our politicians could not put in place some reform to protect hospitals and physicians.

In addition, I've seen many of my friends and colleagues go into the money specialties like radiology and dermatology because they make the most and have the best lifestyles. So the best and brightest usually go for those specialties instead of some more (IMO) important fields like pediatrics and obstetrics. One of the reasons I never became an MD.  I was too disgusted by what I saw was driving people - money and status.  Two things that are alright but not important to me.  And for physicians, it shouldn't be either.

CerebralSmartie
CerebralSmartie

@greedydoc Wow-this is absurd. Thanks for exposing this.

This explains the variance in MRI interpretations. When you get second , third, and fourth opinions on an MRI, there should be agreement about whether there are serious issues. Sometimes there is no agreement. It is baffling.

BobBu
BobBu

Well, that was the first time.  Because I had paid off my office building I was able to return to practice (medicine is too aluring to abandon) being very selective about what I did.  Take my word for it, if a physician is a little frugal, Medicare and Medicaid can yield a modest profit.

seejayjames
seejayjames

@therealdeal Oh, not to mention that every single person in these countries are covered, from birth to death, for virtually every condition (many more than even our best insurance covers). Still the overall cost is a fraction of ours.


Can you explain that?

greedydoc
greedydoc

There are no limits on hours/studies read.  There were no limits on resident hours when I was in medical school but once people found out all the mistakes tired residents were making a law was made limiting residents to 80 hours a week.  I only work 55 hours a week but at the pace radiologists go (just to maximize profit) I don't think the are providing the best care they can.  Their should be a limit to how many MRI's/CT's can be read in a day. Kaiser actually limits it to 30/day so mistakes are kept a minimum.

greedydoc
greedydoc

It is sad.  Radiology is the worst because we are just seeing images... we don't see the consequence of our reads.  No patient in front of us.  

A good system would salary docs.  Docs would then take their time and do a better job.  Cleveland Clinic, Mayo Clinic, a lot of academic hospitals are salaried.  They take their time and do world class work.  Private Practice guys take short cuts and don't think as hard.. worse quality reads. more mistakes.