When the bill came, the amount initially seemed reasonable. The medical center charged her $383.40, and Blue Cross and Blue Shield of Illinois paid $228.10. Rutke was left with a bill of $155.30.And now, doctors are seen as the bad guys.
But when a second bill arrived from Greater Elgin Emergency Specialists, Rutke blew a fuse. The doctor’s group that had attended to her at the immediate care center charged an additional $545.
But when we itemize the costs for for those stitches, where's the money going? Here's just a portion of the "costs" inherent to our current health care system:
- Facility costs
- Rent/mortgage/lights/security/phone/soap dispensers/restroom supplies, website, electronic medical record, etc.)
- State regulatory requirements
- Federal regulatory requirements
- Staffing costs:
- Front desk clerk (to assure proper demographics are entered to assure payment and perform initial triage)
- Nurse (to fill/refill prescriptions, evaluate post-operative wounds, dressing changes, etc.)
- Billing/collections staff (Assure proper billing/forms completion/credentialling of staff/manage accounts receivable/contact insurers/work denials)
- Doctor (ultimate responsibilty for care delivery - covers nights/weekends - must carry malpractice insurance)
- People to answer phone
- People to assure primary insurer pays their part (often Medicare) before the secondary insurer (them) pays theirs
- Managers to hire/fire workers, negotiate with hospitals/employers
- Senior managers and board members (who else will talk to the share-holders?)
- Supplier of sutures, sterile supplies, pharmaceuticals (like local anesthetics), tetanus toxoid, and possibly antibiotics.
- Legal/Regulatory Fees
- Lawyers to draw up employment contracts, HR rules, Quality and Safety guidelines, defend litigation, etc.)
- Malpractice insurance
- Liability insurance
All this for three little sutures at $300 dollars a piece.
Yes, this is what all this costs. In fact, it might be relatively cheap, given all the overhead that some insist continue with our current broken system.
Now, imagine another scenario (not that it will ever happen, especially now). But make no mistake, this is a time of disruptive change in health care. The real question is, which portions of the above costs will patients be willing to scrap in the interest of obtaining affordable health care?