By Bob Sweeney
You’ve likely heard the expression “surprise billing” tossed around lately. It’s a term used to describe the unexpectedly large bills patients often receive for “out-of-network” care. Believe it or not, this issue has become another frontline controversy that contributes to the frustration and disillusionment of practicing physicians. The issue is particularly common for hospital-based docs such as emergency physicians and radiologists.
Thirty years ago, the payment category was called “self pay”, and encompassed anyone who was uncovered by insurance or not covered by whatever insurance was accepted in hospital practices. While much of the “self-pay” population was located in poor inner city neighborhoods, a significant portion was also found in rural communities where self-employment was common. I recall very clearly those days. The billing company was normally either the hospital or a local agency of the ER or radiology group. The billers understood that a certain amount of charity was part of the bargain in hospital-based practice, and that farmers and other self-employed individuals might have to stretch out a payment plan or pay less than the list price. No more!
Today, billing in these organizations is a highly centralized national activity often housed a long ways away, both geographically and emotionally, from the point of care. Hospital-based medicine is dominated by large national groups, such as Team Health, USACS and Envision. The emotional connection between the provider and the patient is a thing of the past. Complicating this equation even more is the role of hedge funds. The major hospital-based medical groups are either owned outright or controlled by hedge funds. Unlike social impact funds or funds focused on long term development of an industry, hedge funds are focused on one thing only: immediate above market returns to their shareholders.
Here is a recent article describing this conundrum in some detail:
The counter position has been articulated by, for example, Jody Crane, MD, the CMO at Team Health: https://www.usatoday.com/story/opinion/2019/09/23/teamhealth-doctors-not-behind-surprise-medical-bills-editorials-debates/2422830001/
Our concern is with the doctor at the point of care. He or she has to deal with the frustrations of a patient or family member who receives a mountainous bill from some company located a thousand miles away. The practicing physicians have no authority to mitigate the bill or to serve as an ombudsman for the patient. Both their income and their actual employment depend upon toeing the party line in the corporate medical group.
Thirty years ago, an emergency physician could intervene to help patients pay their bills over time. As members of the same community, each shared a common goal – to ensure the delivery of excellent care, while making it possible for patients to afford and pay for that care. The local hospital had an interest in preserving good will. But these days, hospital-based medicine has become another commodity profession where the service providers, like Uber drivers or temporary employees, have little stake and no authority in managing the relationship with the patient. It‘s a brave, if troubling, new world!
Robert E. “Bob” Sweeney, DA, MS
Principal & Managing Director