Monday, April 28, 2008

Hospitals poised to embrace "pay as you go" for patient care

There's a front page story in today's Wall Street Journal, "Hospitals Demand Cash Upfront From Patients" (login required) outlining the increasingly common practice of hospitals demanding pre-payment for services to be rendered.

I've been noticing this locally for awhile as well. As the amount of "bad debt" has been soaring from patients defaulting on their obligations which are the co-pays, deductibles, & any other part of the cost they're responsible for on their insurance. The really disturbing anecdote in the story surrounding a leukemia patient being treated at MD-Anderson Cancer Center in Houston is a painful reminder of the schizophrenic nature of American healthcare where we try to balance patient care and healthcare economics. It's stories like this that just convince me more then ever that we're hearing the death rattle of our traditional system as we move to some universal healthcare system.

Sympathy aside however, patients do need to understand their financial obligations under their insurance plans. One of the least fun things to do in medicine is to start sending collection notices to patients for unpaid charges from office visits or surgery. As you'd predict, it's much harder to get patients to pay after services are rendered then it is prior. There are very common misperceptions among many patients about how, when, and how much we're reimbursed for services.

I can still remember a massive weight loss patient after gastric bypass refusing to pay her co-payment of $1000 to our office for removing her excess abdominal skin (a panniculectomy or tummy tuck) because she felt like the $700 her insurer paid for 4 hours work and half a dozen post-op visits was enough. I'm a softie on many of these cases and we waive charges frequently (particularly on breast cancer reconstruction, which is a passion of mine) but we've had to become much more attentive to this issue as we see more kinds of cases creeping up.


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