It seems like the one thing missing in all the Washington political debates over our broken healthcare system is any real consideration of real impacts on real patients in the real world. As a physician who delivered babies in Utah hospitals for nearly twenty years, I’ve seen what can happen to families when costs run amuck. It appears to me now that it is time for patients to play hardball and demand transparency and fairness from hospital providers.
Everyone knows hospital costs are out of control. Thousands of Utah patients are baffled each year trying to comprehend the convoluted prices charged by Utah hospitals for in-patient medical care. Too many Utah families can recount horror stories of huge outstanding balances in the wake of illness, a birth or an accident, with bills still arriving months after.
Because of lifestyle and demography, Utah is among America’s healthiest states, which means relatively low per capita healthcare spending. But a new Utah Foundation report shows that Utah is hardly immune to skyrocketing, unpredictable hospital costs.
The Utah Foundation’s findings indicate that Utah hospital prices keep rocketing skyward without any discernable relationship to the actual costs of providing the services. Cost increases come as much from pricing “shell games” as from miracle treatments. Most patients, busy with other concerns, fail to question billing irregularities, as do their insurers. Market consolidation – fewer hospital choices - takes even more leverage away from patients and hands it to hospitals.
Few people “shop” for hospitalization like they do for everyday goods and services. For one thing, hospitals make price comparison all but impossible. For another, hospital prices seem to derive from some magic formula understood only by insiders, never to be questioned or contested by those who pay them. What other market works like that?
Meanwhile, higher healthcare costs kill job creation and business expansion. With co-payments growing, Utah companies and families have become increasingly desperate for workable options to slow wildly inflating medical costs. How can patients ever protect themselves?
Alternatives are few but promising. Some non-emergent surgical centers only accept cash payments. By eliminating insurance processing costs, they treat for a fraction of the usual price. Concierge practices for primary care are becoming more common and therefore more accessible to more families. Medical co-ops are also promising.
Among the most interesting are claims management professionals who work mostly with self-insured companies to combat unreasonable healthcare costs. They serve as patient advocates who carefully audit hospital bills, ask tough questions, determine the actual hard costs incurred and demand relief from unfair or duplicate - and often unscrupulous - charges. These advocates help employers defend against arbitrary or unreasonable hospital charges, instead demanding fair, cost-based billing.
As a result, such self-insured employers (those who choose to fight back) are among the few groups nationally that have seen actual declines in insurance costs. Obviously, this tactic is unpopular with many hospitals. How dare patients stand up for themselves to contest unfair and excessive charges?
It is clear that we need to introduce patient choice and market competition to healthcare. More providers must be willing to provide services at fair prices, with simple, straightforward billing. We should reward local healthcare facilities that consider the financial needs of patients and their families, instead of those who care more about that new fountain in the lobby of their latest medical “Taj Mahal.”
Businesses and families throughout Utah deserve fair, reasonable pricing for their healthcare. Market competition, patient advocacy and provider transparency are keys to lower hospital costs. That is what Utah patients deserve and must demand.
Dr. Terry Sellers, M.D., is a board-certified physician in addiction medicine living in Orem. He practices in Utah and Salt Lake counties.