They can charge you for that?

PHS 795 student Joe Bates came across an article in the New York Times about a particular itemized charge for delivery services. It reminded me of when my son was born. He had an emergency C-section because of complications during delivery and needed to be resuscitated. I remember when we got the bill, there was a charge for about $100 for infant resuscitation. I remember thinking, gosh that’s the best hundred dollars anybody could ever spend. Talk about cost-effective healthcare!

This one raises interesting questions. I suspect this is more the case of a billing department getting a little administratively out of hand. There may or may not be actual additional costs to the healthcare system for providing skin to skin service after C-section, but the reasonable thing would seem to be to incorporate it into the standard of care and have it become part of the overall charge.

Joe writes:

This article is in line with our public health discussions on the EpiPen controversy. Additionally, it reminds me of similar stories like the 5,000% spike in the AIDS pill Daraprim or the overcharging of Aspirin in hospitals. Some of you may have seen the news about this particular case, but here is the written product from the NYT. The couple was charged just under $40 for “skin to skin after C-sec” on the hospital bill. The Utah hospital spokeswoman claimed this charge was incurred because an extra nurse was needed in the operating room for safety while the couple held their newborn son. Do people believe the cost of this ‘additional safety’ is warranted? Moreover, from a policy and public health perspective, how are charges like these justified in the health care industry and are there ways to change the current system and culture of overcharging? Thanks for your insight.

 

http://www.nytimes.com/2016/10/06/business/how-much-is-it-worth-to-hold-your-newborn-40-apparently.html

 3 How Much Is It Worth to Hold Your Newborn? $40, Apparently

www.nytimes.com

A man posted a bill to Reddit showing that he and his wife were charged $39.35 for holding their son after a C-section.

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12 thoughts on “They can charge you for that?

  1. Thanks for sharing this article.

    This is a pretty fascinating (albeit depressing) story about the charges incurred at hospital visits. It’s remarkable to me that, while the Epipen and pyrimethamine pricing certainly got a lot of press coverage, there are charges like this associated with hospital care all over the place. The most troubling aspect of this, to me, is that had this baby been born at a different hospital down the street, it’s likely the case that this skin-to-skin charge could have ranged from $0 to even more than $40. So you ask a great question about the justification for these charges, because the true arbitrariness of it all makes them sound like rationalizations more than anything else. It certainly beckons a call for more flat rates for total services from hospitals by say, admission and discharge diagnosis rather than specific items and events. This reminds me of a Vox.com story and youtube video about trying to determine the cost of delivering a baby prior to the due date – spoiler alert: it was basically impossible. https://www.youtube.com/watch?v=Tct38KwROdw

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  2. I didn’t realize that hospitals are able to set their own prices for care and procedures if the patient has private insurance or is paying out of pocket. This bothers me, as it seems this could lead to hospitals potentially overcharging their patients to make up for any money lost from Medicare/Medicaid patients (i.e., hospital not being reimbursed due to patient readmission). I’m not sure if there are policies surrounding that, so please correct me if I’m wrong that there isn’t anything to prevent this from happening.

    For those paying out of pocket, those price increases could bankrupt them. The United States is one of the few countries who will allow their patients to go bankrupt due to medical bills, and this is only contributing to that issue. Healthcare isn’t a privilege – it’s a right, and we need to make sure that it is affordable for everyone, and that everyone is billed fairly.

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    • I find the health care system in America extremely frustrating especially when comparing it to other developed nations. Yes, hospitals can charge their own prices for procedures and care. That’s why health care in America is a business. It’s like a mall where you need to go to the right store (hospital) to find the best prices. (I think there is a little irony in the name of the MarketPlace.) However, the health care system, obviously, has the upper hand because they’re selling something that every human needs. Often, there isn’t time to search for best prices. On another note, there are apps that allow doctors to find the costs of prescriptions for their patients, so if they took the time to look, they would be able to prescribe and recommend where a patient get their medications for the best price. On the flip side, patients can try to advocate this process themselves if they know what they’re doing. The point is rather than being a basic right in our country, health care in America is a business and caters to those with the means to pay or the savvy-ness to look around while throwing those without resources under the bus.

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  3. Excellent article, Joe. To me, this highlighted how much farther we have to go as a country to bring our healthcare up to the standards of other developed countries. Our gaps in medicare and medicaid is disconcerting enough, but the nickel and diming is even more troubling. How many hospitals and healthcare providers get away with absurd charges like “skin to skin after C-sec” through complicated itemized billing, misleading the patient(s), or unnecessary procedures?

    Unfortunately, sealing the wholes in legislation that make these bogus charges possible may be impossible. Flat rate payments or bundling procedures may stop healthcare providers from charging women to touch their newborn children, but I am nearly certain another gap would be exploited.

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  4. What an interesting article, I appreciate you sharing this with the class. I think that the high costs for an Epi pen, the rise in AIDS antivirals and now the skin to skin contact during a C-Section is just too much. This is very interesting to me because I have had a similar issue come up for me in my personal life. I have celiac disease – an autoimmune disorder that affects my small intestine. If I want to be able to enjoy a meal out at a restaurant I often have to pay a surcharge for a gluten-free meal, whether it is noodles, bread, etc. I understand that this this not even close to being the same, nor can it be compared to any of the before mentioned events, but it is something that I have had to deal with. It is interesting to me that there always has to be some kind of extra charge or a surge in price for something that someone needs and is necessary to improve their quality of life. I know that there has been a lot of lobbying currently with Congress on reducing the costs of Epi pens, because some individuals simply cannot afford a $500.00 medical device. I have a friend who is deathly allergic to shellfish and this was one of the reasons why she had to forego an Epi pen for many years and hope for the best. I hope that there can be legislation brought to Congress where they can tire these unprecedented decisions and individuals with such diseases, disabilities or necessary medical care can receive it without being punished for such.

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  5. This raises a real question of equity in the hospital setting. Thanks, Joe for posting this article. The person who made this post has a certain amount of things going for him, he said he was aware the delivery would be expensive, that he had money saved up. But what it doesn’t address is that he was also in the position to read and understand his itemized hospital bill. He was able to notice this charge and extrapolate it’s meaning. There are many people who come to the hospital who are not in this position. It’s good to hear that this didn’t have much of an adverse affect on the life of this family, but it begs the question of how many “hidden” charges like this occur daily, all over the country because people lack the time or ability to examine their bill and bring these types of charges into question.

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  6. This begs the question of health equity. Joe thank you for posting this article. This family seemed to have a lot going for them coming into the delivery. They knew it was going to be expensive, they had some money saved up for it. Additionally, they had the time, and the ability to examine their itemized hospital bill and notice discrepancies, and then the position to bring it to public light. Many people coming into the hospital setting do not have these luxuries. It’s great that this charge had such a limited effect on this family, but how often are people subject to these types of “hidden” charges every day in US hospitals? Many people entering the hospital system don’t have the time or the ability to examine their itemized bill for a procedure, or the ability to interpret a listed charge as something that may be questionable.

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  7. This is a great share, especially in the context of the topics of some of our more recent lectures on different payment mechanisms, delivery reform, variation reduction, etc. DeMarco mentioned in his comment, payments like this are arbitrary and could vary among hospitals. This seems particularly ridiculous when thinking about how common the skin to skin contact “service” must be following most deliveries. Why should it cost differs when care at a different hospital would be the same? When I see the justification for this fee (extra nurse for additional safety) it makes me wonder how much time is truly “extra” or should just be considered the standard of care. What would the cost have been for 5 minutes more or less time? Is it a flat rate no matter what? There should be some sort of standard across the board for these questions. Given this is just one example and the added cost was 40$ (which I would consider relatively low compared to overall costs), I can only imagine how variations in other services could result in higher unexpected costs. Shifting payment measures to focus on quality are a good start, but this seems like a rather big issue to tackle without big policy changes.

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  8. Thanks for the responses and comments. I think this article does highlight the business aspect of hospitals and their ability to somewhat exploit patients to maximize profits. However, I do think it is noteworthy to consider Dave’s comment about the birth of his son. After the emergency C-section, the $100-dollar charge for infant resuscitation was viewed as the best hundred dollars ever spent. I think this is an interesting perspective because it illustrates the willingness for individuals to pay for life-saving procedures. For example, some hospitals have been known to charge ridiculous fees for giving an Aspirin to a patient. Yet, in an emergency situation, all of us would most likely pay an exorbitant amount of money to have our lives saved. Nonetheless, I think most of us would agree that using a life-threatening event as the reason for inflating charges to maximize profits is inherently wrong. In the case with skin-to-skin contact, this was not an emergency situation and most likely did not warrant a steep charge. The hospital in this article underscores the safety measures and necessity of staffing an extra nurse as explanations for the high cost. I agree that the reasonable solution is to incorporate the charge into the standard of care for the overall charge, instead of separating it out and inciting undesirable reactions.

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  9. Informative article!
    I am not surprised at hospital charges however, this was shocking to me that one would get charged for holding their own baby! It makes me think of what other charges do we not know about. I think as crazy as it looks, it’s good that transparency is becoming the norm. The other thing to consider is that labor and delivery generally consists of teams of health care staff to help the procedure or “experience” go smoother and safer. This can include, labor and delivery nurse, doctor or midwife, anesthesiologist, circulating nurse, nursery nurse, neonatologist and possibly a NICU RN. Of course, this can also depend on the hospital. I think if they were going to claim that an extra nurse was needed, then it would’ve been better to charge for nursing care instead of adding the nurse as part of the charge for rooming. What a true representation for fee for service medical care. I almost want to recommend may be, get a bundled C-section charge, it might save them more.

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  10. I think this article and the $40 fee to hold your baby bring a light-hearted example to the real issue, which is how patients are billed for services. The father stated the bill item was not the worst thing to find, but as seen by the comments on the reddit page, many patients feel the opposite about their billing receipts.

    As a future physician, I find the fee for service model very intimidating. Granted I still have years of medical training left, but right now the concept of fee for service is not something I am a fan of. From how I understand this now, physicians are responsible for overseeing care and also categorizing the care and service provided to be billed to the patient. This just seems so nuanced and takes away from the real job which is providing quality care. I realize there are materials used in hospitals and costs due occur, but our health care system has to got to find a better way to pay for then charging every little step of the treatment.

    What surprised me the most with this article is that hospitals are at their own digression to charge for service and the amount they are able to. Unfortunately, hospitals put pressure on physicians to perform certain number of X procedures in order to meet their quarterly quotas. This has to change, and I hope to be a part of a movement that positively changes the way we utilize and bill health care.

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  11. SPH,

    You bring up some great points that are very relevant to this article. It is problematic that hospitals have the ability to charge for various services based solely on their discretion. But I fully agree that the management puts pressure on physicians to see a certain number of patients in order to maximize profits. Often, there is a misalignment of expectations among the hospital administrators who value quality of care, yet put difficult expectations on physicians to maximize quantity. I don’t have a solution for the current system, and likely multiple groups are responsible for creating the current structure. Specifically, with regard to fee for service, what would be a viable alternative in your view that could satisfy sufficient quality of care for patients, as well as provide adequate compensation for procedures performed by physicians? Pay for performance has some drawbacks, yet moving toward a focus on quality of care seems paramount. I wonder if there is a way to tweak fee for service to make it more quality focused, or completely move away from fee for service? As it is now, I don’t see how fee for service could ever totally become extinct. Look forward to your thoughts.

    – Joe

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