published Sunday, April 14th, 2013

Kennedy: Stones, head injuries and cost

A few months ago I had a kidney-stone attack. It hurt like heck for a couple of days, but then I got better. My doctor, as a precaution, ordered a follow-up CT scan.

Later, a urologist took me on a CT-tour of my lower torso, where I got to meet my liver, my kidneys and all of my other giblets.

A few weeks later I got a bill noting that my 10-minute scan had a retail price of about $5,000 and that my out-of-pocket cost -- my insurance co-pay -- was $40, which I had already paid.

Happy day.

I tore the bill in half and tossed it into the trash, but I did not forget it. There is a lot of daylight between $40 and $5,000, I thought, and the transaction seems out of whack at both ends.

Ask anyone in the health care business how hospital billing works and they'll generally brush you back with two words: "It's complicated." I don't know about you, but I'm ready for complicated. Ignorance might be bliss, but it's also expensive.

In my job as editor of the Times Free Press opinion pages, I sit in a lot of editorial board meetings. Recently, we've had visits from health insurance executives and state hospital regulators, among others. These are smart people and fine folks, but invariably when you get down to the nitty-gritty of health care cost containment they'll grimace and say -- you guessed it -- "It's complicated."

For instance, I asked the hospital regulators about a recent academic study that discovered that the list price of hip replacement surgeries at hospitals nationwide varied from $11,100 to $125,798. There are too many possible variables to have a proper discussion about this, the regulators said. Essentially, "It's too complicated."

Tell me a Toyota Corolla stickers for $11,100 in Tennessee and $125,798 in Kentucky, and I'll tell you Toyota has a crazy business model. It's not that complicated.

Lucky for us, one journalist didn't think the issue of health care costs was too complex for the common man. Steven Brill's cover story in Time magazine in late February, "The Bitter Pill," is probably the most talked-about newsmagazine cover story since Time asked "Is God Dead?" in 1966.

Brill's piece took seven months to report and write, and he examined hundreds of real-life bills from hospitals, drugmakers, doctors and companies that make medical equipment. I read Brill's piece -- twice -- and it all boils down to one sentence: "Our largest consumer product by far (health care) -- one-fifth of our economy -- does not operate in a free market." The normal invisible hand of the market -- the push and pull of competitive pricing and slavish devotion to customer service -- has been essentially rigged out of the health care industry, Brill reports.

As evidence, he notes that every hospital has something called a "chargemaster" list, an inflated retail price list for all goods and services. According to Brill's report, people unlucky enough not to have private or government health insurance -- like Medicare or Medicaid -- which negotiate prices on a cost-plus basis, get whacked by the "chargemaster."

Examples from his report:

• A $1.50 generic Tylenol pill billed to a patient by a Texas cancer center.

• A $21,000 ambulance and emergency room bill for a sales clerk's bout of chest pains that turned out to be indigestion.

• A CT scan billed at $7,997.54; Medicare would have paid $554 for it.

• An $87,000 one-day outpatient surgery for a back patient to install a small (but expensive) pain-blocking implant.

Hospital patients fall into two categories, Brill notes, those who have good insurance -- public or private -- and don't care much what their medical care actually costs, and those who are under-insured or uninsured and can quickly be pressed into bankruptcy under the weight of "chargemaster" billing. Most hospitals do end up negotiating these costs with their private-pay patients, but results are wildly uneven and unpredictable.

So how do we take all this complicated stuff and apply it to our own lives?

I got a chance to think about that recently when my 11-year-old son got woozy after repeatedly heading the ball at a soccer tournament. A trainer on site recommended an ambulance ride to a nearby hospital and a precautionary CT scan.

Meanwhile, my sister, who works in the health care field, called ahead to an emergency room doctor at the hospital. He listened to my son's symptoms and said he thought he was OK. Still, we drove to the emergency room to have him checked out. There, the medical staff told us essentially the same thing, with the following caveat: "We'll be glad to order a CT scan if you want."

I kept thinking about a quote from the Brill piece: A doctor told him, "You never get sued for doing too much."

Although we didn't have much skin in the game at that point, my wife and I declined the CT scan for our son.

Did we do the right thing?

I honestly don't know. But I do know that sooner or later we are all going to have to start making these "cost vs. risk" decisions about our medical care.

If you think things can stay the same, you're just not thinking straight.

In fact, if you've got good insurance, you might want to get your head examined.

Contact Mark Kennedy at mkennedy@timesfreepress.com or 423-757-6645. Follow him on Twitter @TFPCOLUMNIST. Subscribe to his Facebook updates at www.facebook.com/mkennedycolumnist.

about Mark Kennedy...

Mark Kennedy is the editor of the Times Free Press opinion pages and writes the Sunday “Life Stories” column. He also writes a Saturday automotive column, “Test Drive,” for the Business section. For 13 years, Kennedy was features editor of the newspaper, and before that he was the newspaper’s first Sunday editor. The Times Free Press Life section won the state press award for Best Community Lifestyles four times during his tenure. Before Chattanooga’s newspapers ...

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