In a refreshing move, the Toledo Clinic, a 175-physician group took out a recent full-page advertisement in The Blade that compared laboratory and radiology rates it charges with those charged by ProMedica and Mercy Health Partners, the two main players in the Toledo health-care market. There is a gross inequality in charges between the Toledo Clinic and others.
To my knowledge, it is the first time a local medical facility has advertised its rates for laboratory tests. I wish this practice would extend to the rates for all other services in our area.
Hospitals do not, as a matter of policy, advertise their charges. It is a tradition that has come down from the heyday of health care some 50 years ago. In those good/bad days, insurance companies paid what they called “usual and customary” charges.
That list was secret. Insurance companies profiled individual physicians and determined how much they should get paid. In my early days of practice in the late 1970s, Blue Cross and Blue Shield, the main health-insurance provider, balked at my request for the list of charges.
A friend recently showed me bills he had received for removal of a growth from his neck at a local hospital. The hospital bill was $59,850 for surgery and one day of hospitalization.
Included in the bill was a charge of $46,046 for the use of an operating room. Add to that other charges, and the expense of having a lump removed came to more than $70,000. Not many middle-class Americans can afford to pay such amounts.
If you are thinking insurance would pick up most of the cost, you are right. But in the end, all of us pay for runaway health-care costs.
In a previous column, I suggested that America should follow the lead of other industrialized countries and adopt single-payer universal health coverage. The responses I got were interesting.
Some readers invoked the images of death panels that would determine who lives and who is allowed to die. One of my friends, a successful engineer and business owner, asked, tongue in cheek, whether under universal health care he would be allowed to get past age 75.
Large ideological blind spots obscure reality. While other industrialized countries realized the folly of the fee-for-service concept and adopted some variant of universal health care, we in America are still holding on to archaic ways. But we are making progress, albeit slowly.
Today, more physicians are working for hospitals as salaried employees, and moving away from the sacrosanct concepts of total independence and fee for service. According to the American Medical Association, 60 percent of family physicians, 50 percent of surgeons, and 25 percent of surgical subspecialists such as ear, nose, and throat and eye doctors are salaried. It seems clear that most physicians in the United States eventually will work for individual hospitals as salaried employees.
That brings me back to the Toledo Clinic advertisement. I would like to see all area hospitals advertise their services with a fixed price tag. We already have a federally mandated template, called diagnosis-related groups, that dictates fixed payments for Medicare, Medicaid, and a few other programs based on diagnoses.
Hospitals sometimes make money by being efficient and avoiding inpatient care. In other cases, they take a loss. But they make money under the system.
The concept can be extended to all patients who enter a hospital. They would know up front how much a health-care procedure would cost. There would not be any surprises.
A relentless effort by Congress to undo the Affordable Care Act would stifle efforts such as the one made by the Toledo Clinic. That would send us back into the past.
Dr. S. Amjad Hussain is a retired Toledo surgeon whose column appears every other week in The Blade.
Contact him at: aghaji@bex.net
First Published March 2, 2015, 5:00 a.m.
