Practice Corner Sticker
Shock
in Health Things
Really Know What Richard #{163} Heilman,
Care: Do You Cost?’
MD
In many families, it’s a running joke that the father doesn’t do enough grocery shopping to have any idea what things cost. On the rare occasion that the father finds himself in the supermarket, he may need oxygen to overcome his shock at the checkout counter. Things may not be so different when it comes to the costs of medical care. I gave a talk recently about the diagnostic workup of the colon, comparing, among other things, the costs of colonoscopy and barium studies.
The
colonoscopists
in the
audience
however,
when I teamed studies. Shortly
cago head
was
how
my
much
thereafter,
own
was
objected
my
daughter
job
that
offered
her
medical
for barium
called
to report that her roommate on the very day that she was
from
Chi-
had cut her foreto start the first
insurance.
She
went
All of this
but there the public care these that make
astonishment
charged
reading induces (eg, $ 143 for a bedside chest radiographic examination), try quizzing the referring physicians on the cost of the procedures they order and find out for yourselfjust how comfortable folks have become with spending other peopie’s money. Ask the referring physicians if the high-priced study they have ordered would seem as important if an uninsured family member (or they themselves) had to pay the bill out of their own pockets. this
strenuously that my quoted charges for colonoscopy couldn’t possibly be correct. They were dismayed and embarrassed to learn that I was right. It really did cost $889 for a diagnostic study and $ i,466 if polypectomy was performed. Just as embarrassing,
Intrigued by these costs, I asked some of the emergency room personnel in my institution what we would charge to treat such an injury. As I suspected, no one could answer. I would wager that the treatment team in Chicago didn’t know either. For thought-provoking reading, I suggest that you review the current charges for radiologic and interventional procedures done in your department. After you recover from the sticker shock that
working to
the emergency room of a nearby hospital, where an intern managed to squeeze three sutures in a laceration of less than 1 cm in length and gave her a tetanus booster. The charges for this 30-minute transaction came to $500 for “acute” care and $70 more to take out the stitches. The plight of the 37 million uninsured Americans takes on a more personal flavor when an angry daughter calls and asks, “What’s going on here?”
is not
intended
to sound
like
a scold,
is no doubt that cost is virtually all that has on its mind when it thinks of medical days. Nearly everyone has horror stories $570 for three stitches in an uninsured, woman’s
face
seem
pretty
tame.
Although the startling cost anomalies are usually the creations of thoughtful men and women struggling with a tidal wave of red ink, some charges are so
high
that
the
legal
concept
of res
ipse
loquitor
(the thing speaks for itself) may have to be invoked. Some of these charges are so high and so unrelated to the complexity of the procedure, sophistication of equipment, or hazard of performance that they raise serious questions about the fairness of a billing methodology so unashamedly distorted by cost shifting
that
the
results
bear
no
discernible
rela-
tionship to reality. It seems likely that the howls from the public will soon be so loud that calls from
angry
Index
terms:
gists,
Economics,
socioeconomic
RadioGraphics I
From
the
Department
cepted C
466
RSNA,
U
Aye, March
#{149} Editorials
#{149} Rsdiology
and
members
will
be
seen
as a relief.
radiolo-
issues 1992;
Coichester
medical
family
Burlington, 3. Address
12:466 of Radiology,
Medical
VT 05401 reprint
.
requests
Center
Received
ofVermont,
February
to the
28,
111 1992;
ac-
author.
1992
RadioGraphics
U
HCilman
Volume
12
Number
3
Shock
in Health Things
Really Know What Richard #{163} Heilman,
Care: Do You Cost?’
MD
In many families, it’s a running joke that the father doesn’t do enough grocery shopping to have any idea what things cost. On the rare occasion that the father finds himself in the supermarket, he may need oxygen to overcome his shock at the checkout counter. Things may not be so different when it comes to the costs of medical care. I gave a talk recently about the diagnostic workup of the colon, comparing, among other things, the costs of colonoscopy and barium studies.
The
colonoscopists
in the
audience
however,
when I teamed studies. Shortly
cago head
was
how
my
much
thereafter,
own
was
objected
my
daughter
job
that
offered
her
medical
for barium
called
to report that her roommate on the very day that she was
from
Chi-
had cut her foreto start the first
insurance.
She
went
All of this
but there the public care these that make
astonishment
charged
reading induces (eg, $ 143 for a bedside chest radiographic examination), try quizzing the referring physicians on the cost of the procedures they order and find out for yourselfjust how comfortable folks have become with spending other peopie’s money. Ask the referring physicians if the high-priced study they have ordered would seem as important if an uninsured family member (or they themselves) had to pay the bill out of their own pockets. this
strenuously that my quoted charges for colonoscopy couldn’t possibly be correct. They were dismayed and embarrassed to learn that I was right. It really did cost $889 for a diagnostic study and $ i,466 if polypectomy was performed. Just as embarrassing,
Intrigued by these costs, I asked some of the emergency room personnel in my institution what we would charge to treat such an injury. As I suspected, no one could answer. I would wager that the treatment team in Chicago didn’t know either. For thought-provoking reading, I suggest that you review the current charges for radiologic and interventional procedures done in your department. After you recover from the sticker shock that
working to
the emergency room of a nearby hospital, where an intern managed to squeeze three sutures in a laceration of less than 1 cm in length and gave her a tetanus booster. The charges for this 30-minute transaction came to $500 for “acute” care and $70 more to take out the stitches. The plight of the 37 million uninsured Americans takes on a more personal flavor when an angry daughter calls and asks, “What’s going on here?”
is not
intended
to sound
like
a scold,
is no doubt that cost is virtually all that has on its mind when it thinks of medical days. Nearly everyone has horror stories $570 for three stitches in an uninsured, woman’s
face
seem
pretty
tame.
Although the startling cost anomalies are usually the creations of thoughtful men and women struggling with a tidal wave of red ink, some charges are so
high
that
the
legal
concept
of res
ipse
loquitor
(the thing speaks for itself) may have to be invoked. Some of these charges are so high and so unrelated to the complexity of the procedure, sophistication of equipment, or hazard of performance that they raise serious questions about the fairness of a billing methodology so unashamedly distorted by cost shifting
that
the
results
bear
no
discernible
rela-
tionship to reality. It seems likely that the howls from the public will soon be so loud that calls from
angry
Index
terms:
gists,
Economics,
socioeconomic
RadioGraphics I
From
the
Department
cepted C
466
RSNA,
U
Aye, March
#{149} Editorials
#{149} Rsdiology
and
members
will
be
seen
as a relief.
radiolo-
issues 1992;
Coichester
medical
family
Burlington, 3. Address
12:466 of Radiology,
Medical
VT 05401 reprint
.
requests
Center
Received
ofVermont,
February
to the
28,
111 1992;
ac-
author.
1992
RadioGraphics
U
HCilman
Volume
12
Number
3
