A while ago, I obliquely mentioned that I had some surgery (Kidney stones. All better now–thanks for asking!). As a result, I came down with a severe UTI that forced me to go to an ER in Boston. While my health insurance covered just about all of the cost (minus $50 for a co-payment*), the bill worked out to $2,725.79. For four hours. Bascially, I was admitted, looked at by an registered nurse and a physicians assistant, given saline, had blood and urine specimens taken, and given two ciprofloxacin (and a prescription). In at around 11am, out by 2:30pm, give or take.
What’s crazy about the billing is how the costs were appportioned. The ciprofloxacin (an antibiotic) cost $2.79. The urology and bacteriological/microbiological lab work ran to $206 ($174 for the bacteriology, $32 for the urology). Given that it was a serious infection**, they told me there were going to test for antibiotic resistance, this isn’t unreasonable (I’ll get to that). There were also charges for “laboratory services” of $119 and the chemistry lab of $174, presumably for the bloodwork.
Then there were the big ticket items. “ED level D”–the emergency room–cost $1,514. But this is what will make your eyes boogle out of your head:
IV therapy cost $676.
Yep. Saline. In a bag. With a needle. $676. I once had a pain-free root canal, a surgical procedure involving expensive equipment, for about the same price.
But actually, this isn’t so outrageous. When I described how much things cost, I was really describing the price, and these are two separate things. Because the actual cost of the consumables (the bottle I peed in, lab supplies, changing the bedsheets, the saline, and so on) is pretty small. What you’re paying for is the infrastructure. All of the informatics that provide computerized records? Expensive. The doctors, nurses, and other staff? Expensive. Maintaining surge capacity? Definitely inefficient (you don’t want a ‘just-in-time’ ER when a train accident happens and you have to handle dozens of patients at once). Supporting trainees? Gotta pay ’em. Of course, buildings need to be maintained, utilities paid, etc. And having the support staff to handle dozens of different insurance plans is also expensive.
All of these costs acrue even if no one walks in the door. I hate using business jargon, but hospitals do have a ‘burn rate.’ It’s voracious. Now, I don’t claim to understand why the charges were dumped into the IV therapy category, and not into the general ER expenses category, but if you slashed the reimbursement for the IV, they would charge more elsewhere. They must. Even a non-profit hospital (and this one is) can’t run at a loss. Cutting personnel sounds easy, but is very difficult: if you have a ten percent decrease in ER admissions, you’re not going to cut the staff (a fifty percent decrease, perhaps). Cutting salaries and wages isn’t easy, to say the least–and, given that we do nothing to combat extreme income inequality, probably not good policy***.
It’s difficult. This is why capping insurers’ profits (which is essentially what Obamacare does) is an improvement over the current system. It’s low-hanging fruit, and will save money.
*I don’t understand the logic behind co-payments. If you have good health insurance (which also means a low co-payment), you typically have a decent-paying job. You can afford the cost of ‘just-to-be-sure.’ For people with crappy health insurance typically have higher co-payments and lower salaries, the co-payment can be so punititve, that this is actually discouraging them from getting services they need.
**It was a serious infection: the day before I went to the ER (on the doctor’s orders), after walking a block, my temperature spiked about 1.5 degrees F and I was exhausted and utterly drained (when healthy, I hit the gym most mornings). I had no appetite and, in retrospect, I realize my judgement was beginning to become impared (more so than usual, anyway)–the latter can be a symptom of a severe infection. If you want to know why I didn’t seek attention sooner, the expected post-surgery symptoms mimic the initial stages of a UTI. And for the wonks who argue patients have to manage their care, I am an expert on UTI, and I missed the symptoms for at least a day (in hindsight, it was embarassingly obvious). What chance would most non-experts have?
***Obviously, medical professionals are paid well in most cases. But compare their salaries to the financial sector, and not so much. And this gap has widened.