EDITOR’S NOTE: In the April issue of Healthcare Finance News, the editorial topic revolved around healthcare pricing, consumers and the need for transparency. In that column, editor Fred Bazzoli told the story of Daniel Borenstein, a California newspaper columnist, who questioned the disparity in prices for a drug used to strengthen the body’s immune system during cancer treatment.
Of the responses received, the following letter from the financial office of a women’s clinic in Colorado exemplified the passion and emotion felt by providers in dealing with the ever-present contentious business relationships with payers. Even though strides have been made in improving provider-payer relationships, much work obviously needs to be done.
Printing this letter doesn’t endorse the charges it contains. It does provide an example of the long road ahead to achieving a healthcare payment approach that is less adversarial. Without some degree of cooperation, the road to transparency will be long and hard.
FIRSTLY, I MUST DISCLAIM my opinion is mine and mine alone and does not necessarily represent the opinion of my employer. I read your April editorial and was a bit taken aback by the implication that insurers are honest, and hospitals and providers are not.
We are a reasonable-sized practice. We are one of only two practices out of five or six in town that take Medicaid patients, and we also have a fair amount of no-pay and Medicare patients.
I don’t really recall any of the insurance companies being forced to insure people who don’t pay their premiums because they lost their jobs, but yet we see them for care and often forgo their bills, as do the hospitals.
I don’t pretend to know all the answers, but I do know one thing - payers are anything but honest and are anything but fair, and they attempt to get away without paying things they agreed to contractually by constantly changing policy and procedures.
Doesn’t markup or cost-shift exist in many other businesses? Does it really cost my mechanic $125 an hour to fix my car in addition to the cost for the parts, plus their markup? The last plumber I hired would not install my oven unless I bought it from him; do you think that was because there was a certain amount of markup in his material cost?
We seem to think healthcare is special and thus free from these market forces. I recently was negotiating a rate of pay with a payer for business in my state. The payer said that while it hadn’t given us an increase in reimbursement since Dec. 1, 2005, it simply couldn’t give us one now either.
“Well, if I am being paid the same since 2005,” I asked, “can you tell me if your premiums are the same as 2005?” They were silent. We all know that premiums have risen by double digits, even with higher deductibles and coinsurance amounts. The CEOs of the major carriers make much more than all of my providers put together.
And is anyone looking at drug costs? We stopped buying a particular injectable because our reimbursement from payers was less than what we could purchase it for, and we were a very big purchaser of this drug. Most of the payers have struck a deal with the drug company in question to run the drug through “their” pharmacies, so they pay themselves - how convenient.
As I said, I don’t have all the answers but I sure see a lot of misdeeds, and they are rarely on the part of the provider. I have been forced by the payers to not disclose the fee schedules we’ve negotiated, and it’s part of the contract “they write” for me to sign. I would be totally fine with putting every payer in a list and publishing my charge rates and my insurance rates in the newspaper. But I’d like to at the same time disclose the thousands of people who have walked away from their bills, the indigent care done gratis and the ever-waning Medicare and Medicaid fee schedules. For the record, we provide any self-paying patient who pays at the time of service exactly the same rate we give our payers.
Helene Stout
Director of Business Services
Women’s Clinic of Northern Colorado