Day of reckoning is due for the 'hear no evil, speak no evil' approach to patient costs

The head of the Medicare program was quoted in a national publication this week sarcastically deriding the U.S. healthcare system and blaming doctors, hospitals and health plans for shrugging their collective shoulders and allowing patients to get stuck with huge bills they shouldn't have to pay.

You missed that one, didn't you?

The Huffington Post slyly stuck that quote from Centers for Medicare & Medicaid Services acting Administrator Andy Slavitt in the middle of a typical and otherwise benign story on balance billing and surprise medical bills. 

Benign except on one count: The patient who was the focus of the article paid a $4,400 bill from an out-of-network plastic surgeon who stitched her up in the emergency room. I am probably one of a handful of non-lawyers in California aware of a legal case called Prospect Medical Group v. Northridge Emergency Medical Group, which would have allowed her to tell that plastic surgeon to bill her insurer or stick it in his ear.

The patient, Lisa Bettendorf, didn't know about that ruling and almost certainly never would. Someone working at the hospital probably knew, but definitely wasn't hanging around the ER to tell patients about it. And her insurer certainly knew but said nothing.

That could be the new motto for the healthcare business: "Beware--what your patient doesn't know could help them."

After more than 20 years of reporting on the healthcare business, there's been a long, shifting chain of evidence on how services are and are not paid. It started with the big HMOs restricting specialty care. Then it was inability of those between jobs to keep their coverage. Then it was the big, still-clamorous fight over Obamacare.

More recently it's the ongoing cost-shifting to patients and aiding and abetting ways to not only keep the squeeze on them but also to run up their costs.

There are plenty of examples. The two out-of-network plastic surgeons who collected $250,000 to suture up the kind of wound residents could have easily handled or the sawbones who made a fleeting cameo at a spinal surgery and billed $117,000. Or, in the case of hospital chain Sutter Health, double-billing for anesthesia services.

At the back end, it's providers like Mosaic of Life Care in Missouri running a for-profit subsidiary that sued thousands of the hospital system's patients and obtained legal judgments.

And let's not forget the drug companies that systematically raise prices, even on products that have been on the market since the Korean War.

The reckoning for all this may be near, however, given the current state of this truly odd presidential campaign. How else do you explain Bernie Sanders (the guy who seems to be channeling every cranky shopkeeper from my youth) pushing single-payer and not getting laughed out of the room? Even Donald Trump (the guy with a Creamsicle for a head and a 1950s police department for a security force) is pushing for complete price transparency.

And let's say that little progress is made on the political front in the coming years (given the gerrymandered Congress, that's not a big stretch). The public is not going to get less angry and concerned about what's going on.

Slavitt's loose tongue may suggest his days heading CMS are numbered; he's been acting chief for nearly two years and has been waiting for six months for the Senate to hold hearings on his nomination to the full post.

Nevertheless, he has it right. And when someone in his position is mocking the "See No Evil, Speak No Evil" approach, the current players may soon have little choice but to uncover their eyes and mouths. – Ron (@FierceHealth)

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