The most memorable scene in the iconic film "Network" is when Howard Beale, the deeply troubled news anchorman, exhorts viewers to shout "I'm mad as hell and I'm not going to take it anymore."
The nation's hospitals may be nearing their Howard Beale moment with patients.
Hospitals have been mostly protected from consumer grumbling about their often total lack of price transparency, but evidence suggests it is just a matter of time before that falls by the wayside.
For decades, many hospital patients had fairly comprehensive health insurance and, therefore, were shielded from the actual cost of delivering their care. If they had a deductible, it might have been a few hundred dollars.
But the last decade has ushered in radical changes in health insurance coverage. Most patients now have copayments and deductibles well into the four figures. That's the kind of nut that can cause anguish in a large number of households, particularly those that thought their insurance protected them against a large medical bill that could devastate their finances.
Recent media coverage suggests these patients are indeed mad as hell about their circumstances.
Consumer Reports recently reported that 12 percent of nearly 1,100 adults surveyed said they had spent $5,000 or more of their own money on medical bills in the past year, while 11 percent said they had trouble paying their own medical bills.
That's not particularly eyebrow raising. But the article's headline was: "It's time to get mad about the outrageous cost of healthcare." The magazine also ran a graphic called the "Anger Index" regarding patient response for particularly pricey hospital charges. The one that drew the biggest ire was the $37.50 charge for a single Tylenol--91 percent of those surveyed thought that was "outrageous."
We've seen reporting of these egregious healthcare pricing and billing practices for years. However, there has been little connection made between that and the response from the patients who had to pay for them.
Little more than a week after the Consumer Reports article appeared, Kaiser Health News and the Charlotte Observer jointly reported on the hidden costs charged to patients tucked inside kinds of care that are supposed to be provided under the Affordable Care Act free of charge. Three paragraphs into the article, it quoted an angry patient who would be on the hook for $9,000 for a supposedly free-of-charge tubal ligation. Most of the bill would be connected to hospital-related charges such as anesthesia and her room. "It's a ridiculous loophole," Jennifer Moxley said.
The article concluded patients are pretty much on their own to determine whether preventative services mandated by the ACA will be free or not. To cover its tracks on the preventative care issue, Carolinas Healthcare has been sending letters to patients informing them of their options in advance and suggesting they may be charged for services that go beyond the scope of preventative care. No coverage on whether Carolinas is suing these patients if they don't pay up.
Then there's the case of Peter Drier, the New York City resident who had $117,000 tacked to his spinal fusion procedure by a doctor who showed up while he was under anesthesia. "This was just so wrong--I had no choice and no negotiating power," Drier told the New York Times.
Admittedly, three articles don't make for a trend. But it is becoming clear that as more patients have to shoulder more of the cost of their care, they are getting angry about the inflated prices, the lack of disclosure regarding charges they may incur and the seeming indifference by the provider community to their plight.
How long do hospitals have before they have to be more forthcoming about such charges? An educated guess is they have about five years remaining. By then, there will be plenty more stories of insured patients bankrupted by hidden charges they thought had been worked out in advance, and entitled shrugs by hospitals and healthcare providers. There also will be enough all-claims databases and other price-seeking enterprises online to exert considerable pressure for greater transparency.
If hospitals don't change their finance culture under those circumstances, they may find themselves the subject of protests or even boycotts over their prices and practices. Their patients may not be as mad as hell just yet, but they are well on their way toward getting there. - Ron (@FierceHealth).