Fleeced at the ‘hospital’

April 20, 2013

In the July 9, 2011, IBJ, I warned that employers and patients are paying a steep price for the shift of physician services to hospital outpatient departments. The [April 8] article about physical therapy services is a clear example of this.

Brian Kahn paid a premium of several hundred dollars because the services were billed as a hospital and not as a doctor’s office, even though the physical therapy office was located a few miles from the hospital.

Hospitals are maximizing payments from patients because such differences are legal and acceptable in health care billing. This is no different than a business taking advantage of income tax laws. But patients like Kahn can’t help but feel fleeced when they find out they have higher costs due to billing tactics.

For things to change, patients need to be better shoppers. Unfortunately, with a lack of transparency and a clear understanding of how health care billings work, the deck is stacked against the patient.

While many patients realize services done at a physician’s office should be less expensive, it may not always be easy to know when you are getting a procedure, test or service done “in the hospital” due to the 35-mile rule. And even if it is disclosed that billing is done as a hospital facility, most patients—including Kahn, an attorney and business owner—don’t understand the implications.

At least he didn’t, but he does now. What’s the saying? “Fool me once, shame on you. Fool me twice, shame on me.”

Don Stumpp
past president, Indiana Medical Group Management Association

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