Normally, I find that Time Magazine isn't worth the paper on which it's printed. Pretty cheap paper, too. But the cover story of the February 20th issue caught my eye: Bitter Pill - Why Medical Bills are Killing Us.
As I began to read the piece, I realized that this wasn't a typical, four-page, gloss-over-the-subject cover story. This was 30 pages of in-dept analysis that took the author, Steven Brill, seven months to research, analyze, and synthesize. The article balances the power of the anecdote with the realities of the data. The conclusions are alarming. For those of us that have spent a career in health care, the data, the stories, and the intricacies of the system are not news. But Brill's cover story shines a light in a heretofore dark space for the vast majority of health care consumers in this country.
This is the first mainstream piece of journalism I've read in which the concept of the illusive "chargemaster" is discussed in great detail. The utter lack of logic on which the chargemaster is based is just the beginning of the problem. The real issue is that a great deal of the negotiating that goes on between hospitals and insurance companies revolve around this massive database of fundamentally arbitrary codes and prices. This isn't a fact most of us have to worry about - unless you are uninsured or underinsured. Brill sums it up this way: "If you are confused by the notion that those least able to pay are the ones singled out to pay the highest rates, welcome to the American medical marketplace."
Of particular interest to most regular readers of this blog will be the story of the $49,237 spinal cord stimulator from Medtronic. Not a typo. The patient was actually charged nearly $50k for a SCS (and this was for the device itself and did not include the outpatient surgery charges, the physician charges, or the blankets and surgical gown for which the patient was also charged). And for those of you paying bills in the work comp space based on fee schedules driven off of Medicare rates, there's a lot of discussion about how CMS sets those rates and what it means for providers.
We've spent a lot of time in this country over the last several years arguing about how to pay for growing medical costs. I'm not going to weigh in on that debate. But I do appreciate Brill's view on the subject: "When we debate health care policy, 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?"
Worth a read.
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