One of the current
trends in health care is hospitals acquiring (taking over) private medical
practices. This means that doctors are now employees. This has many advantages
for doctors in that they now have set work hours and are able to plan their
free time because they are only “on call” at per-determined times. They also no
longer need to acquire business management skills because they are no longer
managing their own businesses. Hospitals now have the advantage of having doctors
on the payroll who can be told to order tests from and admissions to the
hospital which owns the practice.
How does this lead to
higher health care costs? If the doctors’ offices are located in the hospital’s
facility a patient seeing the doctor is charged not only the fee for seeing the
doctor but also a “Facility Charge” for the hospital. This is akin to going to
a restaurant and at the bottom of the check there is an extra fee for your
share of the owners rent for the restaurant. Medical care is the only place
where this absurdity is a normal practice.
I recently received a
letter from a local hospital telling me that my insurance carrier is no longer
covering hospital charges at their facility. However, they were quick to point
out that they still had a doctors’ contract with my carrier. At first I felt comfortable
that I could stay with my current physician who I had been using for more than
20 years. However, I called the physician’s office to find out about the “Facility
Charge”. I was referred to the billing office. The account representative in billing
told me that I would now be liable for the $125.00 Facility Charge every time I
saw my doctor.
Think about this for a
minute. Nowadays, a doctor’s fee of $95 to $125 per visit is the norm (at least
in my area). On top of this the Hospital Corporation is adding a $125 Facility Charge.
This means that a simple office visit will now cost between $220 and $250. Is
it any wonder that people do not go to the doctor when they should? Refusal to pay the Facility Charge, I understand, is one of the reasons that my insurer
no longer has a hospital contract with the one that owns my doctor’s practice. Since I have a high
deductible plan, an office visit early in the year will now cost me $220 instead
of $95. Unfortunately, I am now looking for a new doctor.
In addition to this,
the hospitals give one doctor charge for taking an x-ray and an additional doctor
charge for reading it. Why do we need two radiologists? There are all sorts of
other charges that fall into this category.
Many recent surveys of
medical costs and outcomes indicate that the United States has the highest per
capita medical cost and the worst medical outcomes in the western world. Looking at the current hospital based practice
model and its associated charges, high costs combined with poor results are
almost a given.
Perhaps the time has
come for a single payer system that would have the economic power to control costs
and encourage better performance.
