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Philip Betbeze, for HealthLeaders Media, September 2, 2008

Every once in a while, I like to share with you how some readers have responded to my recent columns. Some like what I've had to say, some vigorously disagree, but either way I love to share the more interesting ones with the rest of you.

In some cases, I've edited for brevity and grammar. So without further delay, here are some of the best over the past eight weeks or so, with my commentary.

Hospitals continue to abuse status
This letter came from an advocate for the uninsured in response to my column about the fate of class-action attorney Richard Scruggs, who's now in federal prison.

Mr. Betbeze,

I advocate for uninsured and underinsured patients, and the overwhelming majority of hospitals do not even mention "charity care" programs or uninsured discounts to patients who would easily qualify.

What hospitals do is go after these patients for the inflated list charges. For instance, a hospital might bill $357 for a comprehensive metabolic panel (chargemaster price) and accepts about $20 from CMS for the same panel. Worse, most hospitals bill for equipment and monitors that CMS considers folded into the room/unit/procedure charge and for which it will not pay twice, but uninsureds/underinsureds are demanded to pay these duplicate charges.

As a result of these billing schemes, the list charge description master prices, even if discounted by a percentage, are still egregious and laden with duplicate charges. Regarding inpatient billings from hospitals, this is the norm and not the exception when hospitals sue anyone for billed charges.

Nora Johnson
MED-X
Caldwell, WV

Blue Cross policies unfair…or are they?
The next letter comes from an administrator of a pediatric clinic who feels that a recent decision by Blue Cross Blue Shield of Minnesota to eliminate copays for beneficiaries who use convenient care clinics is unfair to physicians. He offers some ways physicians might be able to fight back on such policies. The letter after that comes from a physician who has a surprising take on the policy.

Hi Philip:

Here we go again. It is against the law if a physician group waives a copay because it is considered steering the patient. The truth, as we all know, is that copays keep down physician visits. So now our bought-and-paid-for lawmakers are allowing mini-clinics and carriers to steer patients [through waived copays].

This should not be a problem [for physicians]. Every physician in Minnesota should drop Blue Cross and let all Blue Cross customers go only to such clinics. Further, the American Medical Association and all the physician specialty associations should send a newsletter to all their physicians to contact the medical director of Blue Cross of Minnesota and insist that if they don't stop this practice, we will resign. Carriers' sales pitch 25-30 years ago to physicians was "sign up with us or your patients will go to the physician around the corner that did sign with us."

Now we can use their tactics.

Harvey Brownstein
Practice Administrator
Clarkstown Pediatrics
Clarkstown, NY

Dear Philip:

This is great news ... for patients in Minnesota. Primary care physicians need the incentive to run their businesses to the benefit of the customers. There's nothing like a little competition to raise the heart rate and improve performance. Point-of-service satisfaction of healthcare consumers probably can't fall much further. All physicians know at some level that much of what they do does not require a physician to do it. And the ridiculous practices of forcing patients to endure an office visit for prescription refills, minor acute illnesses and such are largely unconscionable. The retail clinic movement is most definitely one way to improve access to care while creating real market feedback to a system that sorely needs it. Let physicians go and get a fair price for those things that truly require their level of intellect, training, and skill. The only way they will know what those things really are is to "go cash" and openly and transparently compete with other forms of delivery.

Robert Teague, MD
Austin, Tx

Right on, Michael Freed
This letter comes from a hospital administrator who didn't want to be named as speaking for the hospital, but he applauds one of my favorite sources, Spectrum Health CFO Michael Freed, for comments he made for a HealthLeaders magazine cover story that ran earlier this summer.

Philip:

Freed from Spectrum is right on with his comments. Our hospital is trying to educate the marketplace as to costs and quality (value) and we are not having much luck because the consumer feels it's out of their control and they just do what they are told. It's very depressing, because we have an excellent message to deliver but no one is home, so to speak.

I do want to defend Medicare, though. Although Medicare doesn't reimburse us our costs, why should they? It is not Medicare's fault that people live unhealthy lives for 40 years and now show up needing hips, knees, drugs, and heart surgery. Don't the commercial carriers that were responsible for that person for 40 years have some responsibility to help keep someone healthy and not just plop them on the next doorstep? That's a little unfair to Medicare or anyone else next in line.

I recently went to the Czech Republic and France, who have much lower healthcare costs than the United States. But both countries are facing the same problems the United States is facing—aging boomers and increasing costs. Both have a single-payer system. Both countries have longer life expectancies, but the one major difference I saw was that there are virtually no overweight people in those countries. How can you compare a 65-year-old American, 100 pounds overweight all his life, who smokes, drinks, never exercised, has diabetes, and now needs a total hip replacement to a 65-year-old Czech who is in shape and has no other ailments other than needing a hip due to use? Which one do you think costs more?

It makes my blood boil when people say our system is broken. It's not broken. No one is taking responsibility. Everyone wants someone else to fix the system, which as Freed says, is people. We need to fix ourselves . . . by being more healthy. The government is partially responsible for making healthcare so convoluted now; I have no confidence they can do anything to improve it. The most important thing driving costs and life expectancy is lifestyle! We all want to be fat and happy, but don't consider the impact that has on costs and life expectancy. So we blame it on the healthcare system.

Name withheld by request

Another anonymous letter follows, as the author comments on a column about the recent revelation that CMS has paid millions in claims from prescriptions supposedly written by dead doctors.

I generally avoid running these unless the author has a fear of retribution, which definitely applies in this case.

Dear Mr. Betbeze:

I read your article with great interest. It also got my blood boiling. I am a Medicare-approved durable medical equipment dealer. My company is also accredited by The Joint Commission.

We have provided specialty equipment, (lymphedema pumps), for 16 years. But getting money from Medicare for products, correctly provided, is like pulling teeth. They routinely downcode or deny claims without much thought or examination of supporting documentation. Having been doing this for a long time, I know what to provide and who not to provide to. But Medicare doesn't seem to care.

I am currently fighting Medicare for payment on a breast cancer patient who should be covered under the Women's Health and Cancer Rights Act of 1998. Yet Medicare has downcoded my patient. If a Blue Cross or Aetna did this, they would answer to the Attorney General's office. I know, because I have called them on several occasions. Yet Medicare considers itself above the law.

Now when I read that they pay millions on simple-to-understand fraudulent claims, but deny my legitimate claims, my head wants to explode. I hope you continue to shine the light of day on Medicare's stupidity.

Name withheld by request


Philip Betbeze is finance editor with HealthLeaders magazine. He can be reached at pbetbeze@healthleadersmedia.com.
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