Since the summer of 2013, journalist Elisabeth Rosenthal has been publishing articles in theNew York Times in an ongoing series called “Paying Till It Hurts,” which investigates the incredibly high price of healthcare in the United States. Her most recent entry, which ran on the front page of the newspaper last month, details “drive-by doctoring,” which occurs when medical assistants, consultants, and other hospital employees are charging patients or their insurers hefty fees on top of already-agreed-upon totals. Sometimes these healthcare providers bill 20 to 40 times the usual local rates and often collect the full amount, or a substantial portion.
The article takes as its principle case Peter Drier, who was billed $117,000 after a neck surgery by an assistant surgeon he had never met and who operates outside Drier’s insurance network. The patient recounts, “I thought I understood the risks. But this was just so wrong–I had no choice and no negotiating power.” Rosenthal notes that drive-by doctoring is becoming more popular as insurance companies are reining in the amount they pay to reimburse doctors for their services. Simply stated, the tactic increases revenue for physicians and other health care workers. And these charges are so commonplace that they have become the top complaint to New York state regulators. Rosenthal adds, “Multiple state health insurance companies have tried to limit patients’ liability, but lobbying by the health care industry sometimes stymies their efforts.”
While in Drier’s case the charges were ostensibly for an assistant surgeon to help with his neck operation, this phenomenon can take many forms. These include doctors patients had never seen who stop by to ask how his or her recovery is going, emergency-room staffers who operate out-of-network and bill separately (unbeknownst to patients), or even additional physicians brought in when a resident or a nurse could have accomplished the same task at no additional charge. Other surgical strategies include billing for additional surgeons to observe a procedure or “declaring an operation an emergency,” which makes insurers more apt to reimburse a hospital.
Patients often have a very difficult time fighting these charges. Since insurance examiners are not in a hospital observing procedures, they have no choice but to believe doctors’ accounts of events. Most of the time, Rosenthal observes, “insurers just pay–to protect their customers, they say–which encourages the practice.”
Luckily, New York state legislators have drafted and passed a law that will take effect in April 2015 aims to protect patients from drive-by doctoring and the surprise charges that accompany it. This act states for example, that “patients are not responsible for unforeseen out-of-network charges beyond what they would have paid in-network.”
It is worth noting that medical lobbyists were successful in convincing lawmakers in New York to limit attorney fees in medical malpractice cases, limitations that are so draconian that they create a disincentive for attorneys to undertake medical malpractice claims. We will soon see how medical professionals react when these fee limitations are imposed upon them. As in so many cases we cover on this blog, industry professionals–be they doctors, pharmaceutical companies, cereal producers, or car manufacturers–will almost always choose profits over safety.