Monday, April 29, 2013

Killed By Medical Bills : In Time Magazine, Stephen Brill Tells Us Exactly Why -- By Following the Money.


Time magazine? Yes, and in its decades as a national publication with millions of readers worldwide, Time has never done anything like "Bitter Pill: Why Medical Bills Are Killing Us."

The entire feature section of the magazine devoted to this single subject, 36 pages, 24,105 words? For Time, unheard of.

A report based on seven months of dogged research by a single writer? Yup, and he is Steven Brill, above, the founder of Court TV,  American Lawyers, and  Journalism Online (sold to RR Donnelly in 2011 for a reported $45 million; he's no starving writer).

Ramping up research several notches, he puts today's skyrocketing medical costs under relentless, unprecedented scrutiny. Uncovering and documenting fact after unassailable fact, purging all ideology, he lays out exactly why medical bills in the U.S. are routinely not just outrageous -- but killing us, often literally.

In doing so, Mr. Brill, a master detective, slowly, painstakingly uncovers a money trail leading to  powerful, entrenched, self-enriching masters of U.S. medical billing. The facts are startling. For example, America spends more on health care than "the next 10 highest-spending countries combined."

In the foreword, Richard Stengel, Managing Editor of Time, writes: "U.S health care is a $2.8 trillion market, but it's not a free one. Hospitals and health care providers offer services at prices that often bear little relationship to costs. They charge what they want to, and mostly -- because it's a life-and-death issue -- we have to pay.

"Have you actually looked at your hospital bill? It's largely indecipherable, but Brill meticulously dissects bills and calculates the true costs. He employs a classic journalistic practice: he follows the money..."

When I read Mr. Brill's story, I felt a little stupid. While I have had my own experiences with outrageous medical bills, I was shocked at the brazenness and institutionalization of the mass money gouging that is the U.S. medical system. I think you will be too when you read this important story in Time magazine.

Now, I'm not going to tell you all that's in this Time story. You have to read it yourself. Actually, it's okay with me if you stop reading right now and go and get a copy somewhere (at your library maybe) or see if you can read it online. My feelings won't be hurt.


Still here? Nice to have you stay with me. You can always read the Time story later. For your own information, make sure you do. By the way, I'm getting no money from Time or Stephen Brill. I know, not too bright.

Let me now backtrack a little. I rarely read Time magazine. I've always considered it a publication heavy on hot news, politics, celebrities, entertainment and light on the important issues of the day. For the big issues, I tend to rely on such publications as The New York Times and The Wall Street Journal. I subscribe to both.

One day I saw a short item in The New York Times saying that Time's March 4 cover story was flying off newsstands and breaking records for online readership. Richard Stengel was quoted as saying, "Yeah. It's really struck a nerve and captured lightning in a bottle."

Surprisingly, most of the attention came from young people. Brimming with life, with few thoughts of health and hospitalization, they would normally be expected to be less concerned with medical bills than older folk. But Mr. Brill's article was shared on social media a hundred times more often than the average Time article in 2013, according to The New York Times.

On, one young reader wrote: "This is the only time in my life that I have been interested in buying Time magazine. I'm 30. I'm unsure whether this bodes poorly for them, or well. Maybe I'll find something I like and give it a chance."

To peruse feedback from Time's readers, click here.

Or, if you like, listen to Mr. Brill discuss his Time story in this video.

When I saw Mr. Brill's story getting so much attention -- he was getting dozens of e-mails a day, mostly from young people -- I decided that I had to get a copy. Everywhere I went, Time was sold out.

Finally, like a druggie needing a fix, I went to the Worcester Public Library. The magazine section had plenty of magazines, but no Time magazine. I went up to the library desk. "You don't get Time magazine?" I asked the clerk, a young man. "We do, but they're all out," the clerk said. "Sorry."

I must have been a pitiful figure. The clerk gave me a long look. "Tell you what," he said. "We have one copy here, but not for lending. I'll get it, but you can't take it with you. You have to read it here. Okay?"


He went back into the stacks and came back with the March 4 Time magazine. Then, as if plunking a few coins in my outstretched, beseeching can, he handed me the magazine, smiled, and said, "Enjoy."

I went back to the magazine section table and began reading. While I read Time, my dutiful wife Barbara, who was with me, read her romance novel -- not her idea of romance, I'm sure. On top of that, I put her to work taking this picture of me on my unpaid job.

Already I was thinking that there was a story here for Patient's Progress. 

Because we had to go, I was only able to flip through the long article. But I read enough to realize that this was one important, actually historic, article that I had to read in full. Then I got lucky. Since I was passing a Walgreen drugstore near my home, I decided on the spur of the moment to see if they had Time.

They did, one copy. I grabbed it. I carried it with me everywhere. I left it behind at my son Jon's house. I told him that I had to, had to, had to have it, and would he mail it to me?  Without a single roll of the eyes -- at least that I saw -- he said he would and did so. Thank you, Jon!

I can't possibly do justice here to this great effort by Stephen Brill by trying to summarize all his findings. It would fall far too short. So let me leave you with just a little taste from his historic report in Time:

* Although it is officially a nonprofit unit of the University of Texas, MD Anderson has ... an operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, of $531 million. That's a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise. The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho's total compensation last year was $1,845,000.  That does not count outside earnings derived from a much publicized waver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified "financial ties with his three principal pharmaceutical companies." DePinho's salary is nearly triple the $674,350 paid to William Powers Jr., the president of the entire University of Texas system, of which MD Anderson is a part. This pay structure is ... reflected on campuses across the U.S. -- whether it's Texas, Stanford, Duke or Yale....  Medicine has obviously become a huge business.

* Of Houston's top 10 employers, five are hospitals, including MD Anderson with 19,000 employees.

* America's largest city may be commonly thought of as the world's financial capital, but of New York's 18 largest private employers, eight are hospitals and four are banks.... Health care is eating away at our economy and our treasury.

* The health care industry has spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That's right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

* Every hospital has a chargemaster, a mysterious internal price list. But it is treated like "an eccentric uncle living in the attic" and hospital officials don't want to talk about it. But it means that hospitals can and do charge whatever they like and prices keep going up automatically.

* One night last summer a 64-year-old woman felt chest pains in her home near Stamford, Conn. She called 911 and an ambulance came and took her four miles to the emergency room at Stamford Hospital, a nonprofit institution. After about three hours of tests and a few quick words with a doctor, she was told she had indigestion and sent home. The bill: ambulance ride -- $995; doctors --$3,000; hospital-- $17,000. A total of $21,000 for a "false alarm."

* One summer evening, a 64-year-old woman bus driver slipped and fell on her face in the backyard of her house in Fairfield, Conn. Nose bleeding, she was taken to the emergency room at Bridgeport Hospital, owned by the Yale New Haven Health System. She was there for six hours, "most of it waiting." She saw a resident for about 15 minutes. She had three CT scans -- of her head, face, and chest. The third one showed a hairline fracture of her nose. The CT bill was $6,538. A doctor charged $261 to read the scans. The charge for the emergency room was $908. Also thrown in were miscellaneous charges for instruments, bandages, tubing, and other incidentals. Total bill: $9,418.
Not yet 65 and eligible for Medicare, the woman is paying weekly installments on her bill. Her insurance policy with Cigna, one of the country's leading health insurers, would pay only $2,400.

"When I got the bill, I almost had to go back to the hospital," she said.

There are pages and pages more in Stephen Brill's ground-breaking story in the March 4, 2013 issue of Time magazine. He tells us exactly why medical bills are killing us. Read it. Yes, it's a bitter pill.  But it's a pill we all need to take. So be a good patient-- and take your medicine.


Dr. Ketchum Tells of His Frustrations With Billing and Medicare.

It is another story altogether for doctors outside mega hospital systems. A young doctor, Dr. Jonathan Ketchum, with his own practice in Worcester, Mass., told me of his frustrations with the medical billing system. The full interview is here. Following is an excerpt:

 “When you think about it, paying the doctor is really the patient's responsibility. A patient walks in here of his own free will and asks me to take care of him. The agreement is I take care of him and he pays me for doing so. But in the world of Medicare and third-party payers, patients don't know how to navigate a very complicated reimbursement system. So we end up doing it. Somebody has to do it or we don't get paid.”

“In other words, you end up with the responsibility of doctor and patient.”

“Yes. And in dealing with Medicare, we go through the exact same frustrations that the patient would have to go through. Say I want to question a claim denial and want to talk to a human being. When I call, I have to press a whole series of options and then get put on hold. I don't have time to be on hold; I have patients waiting to see me.”

“Not what you signed up for?”

“No. I signed up to be a doctor and to take care of people. That's the part the system doesn't even recognize. I operate on Wednesdays and Fridays. On the night before, I lie in bed awake thinking about what I have to do and how to make sure I do it right. I run what-if scenarios over and over about everything from first incision to closing. Then I go into the office the next day and find out how Medicare is banging me on the head.”

The reimbursement problem is not just with Medicare, Dr. Ketchum says. He gives an example of a patient covered by Blue Cross. “I operated yesterday on a woman. I put screws on both sides of her ankle. But for all the time I spent with her, I'll be lucky to clear ten bucks an hour after I pay the overhead and all those people out front.”

Later, I talked to one of those people out front, the one responsible for billing and reimbursement, and asked about the example cited by Dr. Ketchum. She retrieved the patient's file. She said that she could not give out her name or discuss her specific case, but could give the treatment and billing for an injury such as hers, a fractured left foot.

She said: “The surgery took two hours. He put in five whole plates and five screws. He saw her for a 30-minute post-op appointment. After the surgery, there is a 90-day global period. During that time he saw her eight times for about thirty minutes each time. Altogether, it came to about six hours of face time. There was also about three hours of paperwork. We billed $1,000 and were paid $480.”

So long and keep moving.

                                Amazon E-Books by George Pollock

"State Kid: Hero of Literacy" is fiction based on his real-life experiences growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of his being locked up for 23 hours with killers in a maximum security prison; "I, Cadaver" is about his postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story that literally saves his life; "A Long, Happy, Healthy Life," is about how to live the title every day; and "Unlove Story," Writing anonymously as "Elvis," a husband, dumped after 38 years of marriage, lets it all out on love, marriage, life, everything. A guy doing this? It's unheard of.
For the Nook:

A Beautiful Story
A Long, Happy, Healthy Life
I, Cadaver

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