Categories
Committees

The Committee Menagerie

Recently, my son jumped up from the dinner table and ran outside. It turns out he was chasing a Pokemon on his iPhone. There are hundreds of different Pokemon and as it happens, there are also dozens of different creatures that inhabit the committee menagerie. Whenever I sit down at a hospital committee meeting and look out over the attendees, there are always a few distinct species that are there, each with its own fairly predictable behaviors and powers. Here are some of the more common ones:

Snoozeum. A nocturnal beast who sleeps during the day. In committee meetings, it will occasionally wake up for donuts or free lunch. Harmless but during meetings, can be annoying when snoring and can be disconcerting when it has undiagnosed sleep apnea.

Hyperbolator. Easily identified by its unique ability to use 50 words in a 10 word sentence. He has a symbiotic relationship with snoozeum and is the only creature who will cause snoozeum to sleep despite availability of donuts.

Drone-onicus. Although evolutionarily related to Hyperbolator, this species possesses considerably greater endurance than Hyperbolator and is able to suck the life out of a meeting by speaking for up to 30 minutes on a single breath without pause. It typically becomes increasingly tangential with its thoughts and speech the longer it talks. It has the unique quality to turn any committee attendee into a Snoozeum and can often be identified by bringing 40 PowerPoint slides for a 5 minute presentation.

Obfuscatam. This animal can be identified by its sound. When asked a question that it doesn’t like, it will answer with a response to another question that it does like. More often found in political habitats, Obfuscatam does sometimes venture into the hospital habitat where it leaves a trail of head scratching physicians uttering “What did he say and what does that have to do with anything?”.

Negatorus. This is a species that is a remote ancestor of Eeyore of the hundred acre wood. It never met an initiative that it likes and has the ability to see the worst possible outcome of any new venture. It is convinced that something bad is always going to happen. It becomes agitated when exposed to sunny days and puppies.

Textasaur. With thumbs that move as fast as hummingbird wings, Textasaur is in constant motion. Not much is known about its facial features since it rarely looks up from its smartphone. Usually found near electrical outlets in order to maintain its phone’s seemingly high metabolism rate. Textasaur is harmless in large committees but in small committees of 3 or 4 attendees, Textasaur can be highly annoying.

Typeasaurus. You’ll never see a Typesaur as it never attends meetings in person. The only true evidence of its existence is during conference calls. Characterized by the lack of a mute button on its phone, it uses the speaker setting on its phone in order to free up its hands to type on its keyboard. By placing its phone strategically close to its keyboard, it is able to amplify the key strokes for everyone on the conference call to hear and is easily able to drown out all voices on the conference call. It is believed that  the loudly amplified keystroke noises are a mating call for other typeasauruses.

Ruminatadon. Moving at sloth-like speed, Ruminatadon thrives in committees and can chew on a single decision for an entire hour without swallowing. Usually requires an additional month to fully digest any proposal and asks for a follow up committee meeting before it will make any decision.

Granddadasaur. It starts most comments with “Back when I was a resident…”. It laments the loss of the paper medical record and longingly recalls delightful hours spent waiting at the radiology film library window. Outside of the hospital, it often submits letters to the local newspaper editor believing that political change alone can bring back jobs from a happier time, such as blacksmith, canal boat captain, and slide rule manufacturer.

Rantasaur. This creature can be identified by its ability to change color from pale to bright red when it speaks. Rantasaur is perpetually angry at some other species and has a perception of perpetual victimization. It has been known to undergo spontaneous combustion during particularly severe tirades.

Narcissizard. This species cannot let a meeting or grand rounds go by without asking a question or making a comment. Most of its utterances don’t have much to do with the topic at hand but the animal is certain that the meeting attendees cherish its every word. It can also be found in the surgery locker room looking into the mirror and asking itself questions, then smiling.

Copernicusipus. Convinced that the entire hospital revolves around its own territory, this species is unfamiliar with other habitats within the hospital. With an insatiable appetite for hospital resources, if not tightly reigned in, the creature can single handedly consume the entire hospital budget for a year. Often found to express indignation when a committee votes to budget one unit to get clean bedsheets for patients while denying its personal request for a second double expresso moca latte caffeinator machine for the physician lounge in its own habitat.

Intimidatadon. This carnivorous beast possesses large fangs which it frequently bares in order to frighten other species into getting its way. It is highly venomous and particularly malodorous. It is able to go for up to 6 months without having anything nice to say about anyone.

July 20, 2016

Categories
Hospital Finances

Articles about hospital charges will never get you a Pulitzer

Every year, an eager young reporter will call up hospitals in some large U.S. city and ask how much they charge for procedures like a hip arthroplasty, MRI, or obstetric delivery. He or she will become outraged to find out that there is enormous variation in the amount that different hospitals charge and write a newspaper article exposing the “high cost” hospitals and hoping to be rewarded with a Pulitzer Prize. All I can do is shake my head and sigh.

If you are a foreign prince coming to the United States to get your hip replaced, this information may be valuable to you but if you are an average American, the hospital charge is irrelevant. The reason… almost nobody pays the amount that appears on the hospital charge list.

If you are 68 years old, the cost of your hip replacement is going to be (almost) the same at any hospital you go to and that is because the hospital and the orthopedic surgeon get paid the amount that Medicare will pay for a hip replacement regardless of what the hospital or the doctor charges. I say almost the same because there are some minor adjustments in what Medicare will pay based on the geographical location of the community, whether the hospital is a teaching hospital, etc. but the amount is pretty close for all hospitals.

For people under age 65 on Medicaid, it works the same – regardless of how much the hospital “charges”, Medicaid pays only the same fixed amount. For those people under 65 who have commercial insurance, it is a little different: the insurance company will usually have a standard rate that they will pay regardless of the hospital charge and when the hospital and the insurance company negotiate a contract every few years, the hospital will agree to what that rate will be. Big hospital organizations can often leverage their size or notoriety to negotiate rates that are higher than the “standard rate” (but that is a topic for a separate post).

For most hospitals and most physicians, the “charge” for a hip replacement will be 1.5 to 3 times higher than what commercial insurance companies will pay. So why set the charges so high if it doesn’t affect how much you get paid? Two reasons:

First, the hospital (or doctor) always wants to set the charge for a procedure higher than whatever the highest-paying insurance company will pay for it so that they don’t leave money on the table. For example, lets assume Medicare pays $400 for an MRI test, insurance company A pays $450, and insurance company B pays $500. If the hospital charges $400 for the MRI, then that is all insurance company A and B have to pay so the hospital will leave $50 from insurance company A and $100 from insurance company B on the table. On the other hand, if the hospital charges $600, then they will get paid $400 from Medicare, $450 from insurance company A, and $500 from insurance company B.

Second, sometimes, the hospital will get paid whatever they ask for with their charges. This doesn’t happen very often but if your hospital has a lot of foreign princes flying in for their hip replacement, then it makes sense to ramp up the charges since that foreign prince will pay whatever you charge him. There are a few rare occasions when an insurance company will pay whatever the “charge” is – in my experience, this mainly happens when a lawyer or an insurance company pays a physician to do an independent medical examination for disability determination. The hospital charge can also apply to people who don’t carry insurance; this was pretty common before the Affordable Care Act when the percentage of our hospital’s patients who were uninsured was running about 13% but since the ACA was enacted and Medicaid was expanded in Ohio, our uninsured percentage has dropped to < 3%. Most of those who remain uninsured have low incomes and the hospitals will usually negotiate some reduced charge based on the patent’s ability to pay or write it off completely if the patient is indigent.

If you want to find out what Medicaid pays your doctor for a procedure or service, you can look up the current Medicare Medicare Physician Fee Schedule Search – regardless of what your doctor charges, this is what he or she is going to get paid by Medicare.

So next time you come across an article about unfair hospital charges written by an infuriated reporter, do what I do… skip to the sports page.

July 19, 2016