Dodging Healthcare Cost Controls For Fun And (Mostly) Profit
September 23, 2014 3:17 PM   Subscribe

The New York Times reports on a new way medical professionals are gaming the system (to the tune of $2.8T a year) - by making end runs around cost controls through out of network consultation calls.
posted by NoxAeternum (28 comments total) 13 users marked this as a favorite
 
I suppose there is some sort of technicality whereby they're not exactly violating the hippocratic oath with these shenanigans?
posted by grumpybear69 at 3:19 PM on September 23, 2014


uh...2.8T is all of the nation's spending on helth care...
posted by Dmenet at 3:24 PM on September 23, 2014 [6 favorites]


Yeah, I think the OP misquoted.
“The notion is you can make end runs around price controls by increasing the number of things you do and bill for,” said Dr. Darshak Sanghavi, a health policy expert at the Brookings Institution until recently. This contributes to the nation’s $2.8 trillion in annual health costs.
In any other field you'd simply refuse to pay for any services rendered by an unapproved vendor. It's like getting an extra bill for your tax prep because your accountant showed the file to a colleague. On the other hand, good news, you're not dead.

Anyway, single payer, yadda yadda yadda.
posted by GuyZero at 3:28 PM on September 23, 2014 [12 favorites]


Dr. Mu’s office did not respond to requests for comment.

I would like to hear their side of this story.
posted by bukvich at 3:34 PM on September 23, 2014


Dmenet: "uh...2.8T is all of the nation's spending on health care..."

Just... really, super out of control.
posted by boo_radley at 3:34 PM on September 23, 2014 [1 favorite]


The biggest evil (not addressed by the article, even) is that somebody, somewhere with some awful insurance is going bankrupt, right now, over some similar, and similarly fictitious amount. Bankrupt.
posted by Dashy at 3:42 PM on September 23, 2014 [8 favorites]


Yeah, I misquoted there.

Basically, the problem is that the current system allows them to bring any qualified person in on a consult and bill at their rate, even if they are overkill for the task. It's just really disgusting, even if it's legal.
posted by NoxAeternum at 3:45 PM on September 23, 2014


This is horrifying.
posted by palmcorder_yajna at 3:46 PM on September 23, 2014


More proof (as if we needed it) that teaching entire generations that the market will turn all greed into good things for everyone is broken.

High ideals of professional service were a thing once, even if unevenly respected. And guess what? They're essential for the smooth running of the modern free market, and they can't be created by the market. You can't have judges running on greed. You can't have regulators running on greed. You can't have teachers running on greed. And you can't have doctors running on greed. Not if you want a modern, productive, sustainable free market economy.
posted by clawsoon at 3:47 PM on September 23, 2014 [16 favorites]


When I was getting my PhD I accidentally wandered into a seminar for physicians on how to get tax breaks. (I thought it was a regular medical seminar and didn't know I was supposed to have paid for the privilege to be there.) Among the suggestions of the speaker: hire your young children as employees, put down their salaries as expenses and never pay them because they are too young to sue you. (Or pay them by putting the money in your child's college fund.) Instant savings.
It was an eye-opening hour.
posted by dances_with_sneetches at 4:03 PM on September 23, 2014 [7 favorites]


More proof (as if we needed it) that teaching entire generations that the market will turn all greed into good things for everyone is broken.

If we had stable money, people might be less anxious about money. Anxious people can do bad things. I blame the government.
posted by IndigoJones at 4:16 PM on September 23, 2014


If we had stable money, people might be less anxious about money. Anxious people can do bad things. I blame the government.

Is this ironic/joking? I can't even tell. Please re-assure me that it is.
posted by Balna Watya at 4:36 PM on September 23, 2014 [9 favorites]


Among the suggestions of the speaker: hire your young children as employees, put down their salaries as expenses and never pay them because they are too young to sue you. (Or pay them by putting the money in your child's college fund.) Instant savings.

Wow, for the first time in my life I just had a fantasy about reporting someone to child protective services.
posted by You Can't Tip a Buick at 4:40 PM on September 23, 2014 [3 favorites]


The medical profession itself seems to be a significant factor in our healthcare system's inability to match other countries with similar GDPs. They lobby to keep their numbers artificially low, despite tremendous patient loads, to keep their salaries exorbitantly high,
and they run scams and schemes like this even with the fortune they're already pulling down. I firmly believe Doctors should be exceptionally well paid for their learning and judgement, but not to where they're buying thoroughbred horse farms.

If we had stable money, people might be less anxious about money.

Hee hee! Goldbugs.
posted by Slap*Happy at 5:39 PM on September 23, 2014 [2 favorites]


A year ago, my wife had a seizure while we were traveling in Thailand. Through stupid blind luck, we happened to be a few blocks away from one of the top ten medical tourism hospitals in the world.

Ambulance ride.¹ Overnight monitoring in a private room in the ICU. 24-hour care from multiple nurses. Three visits with a neurologist. CT scan. Two MRI scans.² Blood tests galore. IVs. Prescription drugs.

Everyone spoke passable English, and there was always someone fluent nearby. The conditions, technology, and attention were profoundly better than the hospitals I've seen in the wealthy suburbs of Washington D.C.

It cost us $3,300. WITHOUT insurance. At the peak of the Baht's value relative to USD.

So yeah, if you're sick with something that can survive a thirty hour flight, and if Thailand gets their shit together politically, Bangkok is the place to go.³

In the meantime, I remain horrified at how ludicrously backwards our system is that it (1) enables shit like described in this FPP, and (2) makes medical professionals feel like they need to do shit like this. I mean, what in so many fucks are we paying for in this country such that this is even a thing?

¹ We didn't know there was a hospital so close, but it was a panic situation for me so I might've done it regardless.
² Her claustrophobia complicated the first one, so they booked us for a different machine within an hour.
³ My advice is to stay in the hospital while you're there, it was the best place we stayed in the city.

posted by Riki tiki at 6:05 PM on September 23, 2014 [9 favorites]


I mean, what in so many fucks are we paying for in this country such that this is even a thing?

Profits for the insurance companies?
posted by jeather at 6:09 PM on September 23, 2014 [5 favorites]


Why can't the insurance companies just state in their policies that they will not pay if the need for these additional doctors is not clearly disclosed ahead of time, along with the approximate cost? And that they will indemnify the patients against any lawsuits or collection actions by the doctors. If the doctors want to sue the insurance companies they can go ahead, but leave the patients out of it.
posted by any portmanteau in a storm at 6:56 PM on September 23, 2014


Is it going to get to the point where I have to have my PCP and surgeon and nurses and orderlies and cleaning staff sign waivers saying they will not subcontract the work to anyone else?

Perhaps I should have it tatooed on me or on a barcode or QR code. Or I just need somesort of facial recognition system impanted where a prerecorded message plays and says "if you talk to or interact in any way this patient, you assume the contractual obligations laid out at http://donotfuckmeplz.org"

or perhaps OH FUCK IT
posted by lalochezia at 6:00 AM on September 24, 2014


The solution, of course, is to have the richest doctor in the world "fix health care". Because no-one knows how to solve problems that mostly affect poor people better than a rich guy with a technological fixation and questionable ethics, am I right?
posted by clawsoon at 6:28 AM on September 24, 2014 [1 favorite]


Great. Now I'm even more afraid to set foot in a hospital. Now I'm even more afraid to need serious health care, for fear that it will bankrupt me or cause a nervous breakdown after fighting with collection agencies.

Fuck.
posted by the matching mole at 8:36 AM on September 24, 2014


I mean, what in so many fucks are we paying for in this country such that this is even a thing?

Profits for the insurance companies?
posted by jeather at 9:09 PM on September 23 [3 favorites +] [!]


Under Massachusetts mandatory health care system insurers are required to use a minimum of 80% of the premium to actually provide healthcare. If they use less you get a refund.
posted by Gungho at 9:07 AM on September 24, 2014


Why can't the insurance companies just state in their policies that they will not pay if the need for these additional doctors is not clearly disclosed ahead of time,...?

Probably because of the long line of lawyers waiting to sue insurers for limiting care and causing loss of life or limb should these imposed limits cause such an injury.
posted by Gungho at 9:10 AM on September 24, 2014


Among the suggestions of the speaker: hire your young children as employees, put down their salaries as expenses and never pay them because they are too young to sue you.

Not sure how it works in the US, but AFAIK in the UK the tax authorities would take a rather dim view of anyone running a small business and doing something like that. They can be quite strict on what they class as an allowable expense, and will come investigating if they think you’re taking the mickey…
posted by 43rdAnd9th at 9:11 AM on September 24, 2014


Why can't the insurance companies just state in their policies that they will not pay if the need for these additional doctors is not clearly disclosed ahead of time, along with the approximate cost?

Because shit does, in fact, happen in the OR. The waiver you sign was intended to allow for specialists to be called in if things went pear-shaped, in order to keep you alive. The problem is that, when the system started cracking down on costs, doctors started to look for ways to maintain their level of pay.
posted by NoxAeternum at 10:10 AM on September 24, 2014 [1 favorite]


Dashy: The [second] biggest evil (not addressed by the article, even) is that somebody, somewhere with some awful insurance is going bankrupt, right now, over some similar, and similarly fictitious amount. Bankrupt.
FTFY, because the biggest evil is obviously that people are dying from inadequate health care due to the US' malignant insurance system.
posted by IAmBroom at 11:12 AM on September 24, 2014 [1 favorite]


Things fucked up in healthcare, in order.

1) Insurance Companies.
2) Fee for Service.
3) Administration costs of medical facilities required to deal with #1, and #2
4) Your 401(k)s investment in Insurance Company stocks.
5) Momentum.
99) Actual Doctors (sure, there are a few self-important asses in various fields, but overall the actual caregivers are much, much better than the horrifically broken version of capitalism that surrounds them)
posted by DigDoug at 12:21 PM on September 24, 2014 [1 favorite]


Except that the whole system we have for minting new medical doctors is designed to push the conceit that they should be paid exceptionally. You think it's just coincidence a new doctor graduates a quarter of a million (or better!) in debt?
posted by NoxAeternum at 12:38 PM on September 24, 2014 [1 favorite]


My mom has cancer, so she sees an oncologist regularly. Earlier this year, she contracted salmonella, which (skipping lots of stuff here) led to her being diagnosed with c.dif, then ultimately having to have an illeostomy after her colon exploded. She spent 29 days in the hospital and was seen EVERY SINGLE DAY by her oncologist, his PA, the surgeon, the gastroenterologist, the nephrologist and finally the hospitalist. And not the same guys every day, it was who was doing hospital rotation that day. It was a nightmare having them all come in throughout the day, give conflicting information and orders and then trying to figure out who actually was in charge of her care.
posted by hollygoheavy at 12:47 PM on September 26, 2014


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