The public is fed a lot of misleading information about health care prices. Contrary to popular myth, health care “competition” does not bring down prices. In fact, health care prices will continue rising until Congress regulates them.
But, Congress is practically silent on the issue of regulating health care prices. It is allowing Wall Street to call the shots. And, Wall Street is taking full advantage, buying up big pieces of the health care industry–physician and dental practices, hospitals and more–and raising prices as quickly as it can.
Elisabeth Rosenthal reports for the New York Times on her experience visiting two hospital medical centers, operating under very different rules. She went to Johns Hopkins Medicine in Maryland, the one state with regulated hospital prices–and a hospital she would not name in New York,, which has no price regulation to speak of for health care. The cost for her treatment with a neurologist in Maryland was a fraction of the cost in New York,, $350 v. $1,775.
Rosenthal makes the point that hospitals do not need to charge $1,775 for a neurology visit to deliver excellent care. Johns Hopkins delivered as good care. The big difference between the two hospitals is that Johns Hopkins has lower profit margins and not all the over-the-top bells and whistles that many of the high-priced hospitals have today.
Meanwhile, the Daily Poster reports on concerning behavior among Wall Street entities owning physician practices. One private equity firm, KKR, which owns emergency room physicians, did not want to share its billing codes with its physicians. It apparently wanted to protect its doctors from being charged with engaging in fraud. KKR seemed to fear that transparency in its billing practices would put physicians it owns on notice of the services KKR was billing insurers for, which they might not believe they had performed.
This all said, price regulation is not enough in some instances to keep costs from escalating. You also need oversight and enforcement. A story in Kaiser Health News reports on Justice Department action against Kaiser Permanente. A whistleblower reported that more than half of its doctors say they were pressured to add diagnoses to Medicare patient records that they had no basis for adding. These additional diagnoses increase Kaiser’s Medicare Advantage revenues. (The government pays Medicare Advantage plans more for patients with multiple diagnoses.) The Justice Department found a 75 percent error rate in diagnoses codes.
This practice of “upcoding” (the term for adding additional diagnoses codes) appears to be quite common among Medicare Advantage plans. One analysis found that the government would be spending $355 billion more over the next eight years than it should be spending for people in Medicare Advantage as a result of upcoding. It needs to be addressed, but so far the government is letting it happen.
If we improved and expanded Medicare for all, we would not be dealing with any of these issues.
Here’s more from Just Care:
Leave a Reply