In Medicine, More Is Not Always Better

What hospitals lobbied too hard to receive and prevent doctors in practice from receiving may have backfired on them. I say just deserts for your greed, hospitals. This New York Times article paints the correct picture. I can only call the tactics by hospitals as bullying tactics, not lobbying. What the Times article leaves out is the amount of money used to support congressional backers of the bill that favored the hospitals and now may need to be repeated. This of course will come out of the pockets of patients and taxpayers.


At least the Medicare Payment Advisory Commission is seeing the cost difference created by the hospitals with their “facility fee” addition to all submissions to CMS. This is done for hospital outpatient clinics that are part of the hospital and facilities where the hospital has established clinics by purchasing an entire physician practice.  A physician’s practice that is purchased by a hospital often stays in the same location and treats the same patients, but Medicare and Medicare beneficiaries pay more for the same services.


The 17-member Commission uses the following examples to show the disparities between hospitals and independent physician practices. An office visit for 15 minutes to an independent physician practice is reimbursed to the practice for $58 and the patient pays an additional $14.50 for a total of $72.50. The hospital receives $98.70 for the same consultation and the patient pays $24.68 for a total of $123.38 or a combined $50.88 more for the hospital.


Then consider a certain type of echocardiogram, Medicare and the beneficiary pay a total of $188 when this takes place in an independent physician practice. The same test done in the outpatient department of a hospital yields a total cost of $452. The hospital gains $264 over the physician practice. This hardly seems fair or justified for the patient.


The USA Today article says a study found that tens of thousands of times each year, patients undergo surgery they don't need. This calls for patients to be more vigilant when procedures are recommended involving surgery. Yes, the author blames doctors that are bad apples, but often I wonder why patients don't seek a second opinion.


Yes, patients have part of the responsibility for pushing doctors to take action for them or their loved one, when in fact, doing nothing or medically treating a condition may be the better course of action. Also, consider that the current medical system does provide incentives to perform a costly procedure instead of medical management.


As a patient, we need to learn not to be so trusting of our doctors and seek one or more opinions. The money you spend for that second opinion may just prevent you from bearing the total cost of surgery when Medicare or your insurance says it was not necessary and refuses payment.