The Hospital that Stole Christmas

My wife loves getting a deal. This past month, she had been doing some holiday shopping and she’s constantly looking for the best possible bargain. She’ll shop around four or five stores before she’ll finally settle on something that she’s been dying to buy, and even then, she’s constantly wondering if she got the best value for it. For my wife, the cost and the value of something are two very different things. For her, buying a pair of shoes for my son at Macy’s for $50 is the worst feeling in the world if she finds out that the same shoes are selling for $20 somewhere else. Who can blame her, they’re the same pair of shoes. No one likes paying more for something, unless there’s money to burn.

My wife was telling me the story of the $50 shoes when I met Janet. Janet, a forty six year old female, came in for follow up from the emergency room. She wasn’t admitted for pneumonia or congestive heart failure. Instead, she was diagnosed with bronchitis and sent on her merry way. When I asked her how she was feeling, she said, “lousy.” “They didn’t do anything for me other than make me wait three hours, take an x-ray and give me some medication.” I wasn’t sure what Janet was expecting, but typically, most patients feel that way about emergency room visits. When I asked her why she was following up with me she said that that’s what they told her to do. “On the discharge instructions, it said to follow up with my primary.”

Year after year, the cost of a trip to the emergency room is climbing. By some estimates, the average cost is around $1500. And while insurances cover ER visits, typically there is a copay of anywhere between $50 to $150. And if there’s a deductible to be covered, guess who’s responsible. Without insurance, it’s quite a bit more. The cost of a simple upper respiratory infection in an ER can cost anywhere from $400 all the way to $2000 depending on the complexity of the tests ordered and the cost of the facility providing them. Most patients that enter an ER are never thinking about cost, they are thinking about feeling better. The truth is that to get over a cold, the cost of a bottle of Nyquil is all you would really need.

The problem with emergency room visits are that the prices set forth by the hospital are never fixed. There is the price that they charge insurance companies, which can include a $60 ibuprofen tablet to a $1000 chest x-ray, and then there is the price that they charge the uninsured consumer. There are also location considerations, where certain hospitals are busier than others. Once an insurance pays out a claim, the insurance will dictate the terms of the amount that they will pay, meaning to say that the insurance will not pay the full amount on the claim if they deem the price tag unfair. So, that hospital bill that’s $10,000 for a pneumonia will only be paid out $3000 as that may be deemed the fair price. Guess who gets the balance?

While emergencies do happen everyday, and it may feel as if a cough that hasn’t relented for two weeks is an emergency, it truly isn’t. The emergency room’s resources are specifically for just that, emergencies. When a patient comes in for a cough, those resources are stretched for nonemergent reasons and can potentially affect true emergency situations. In other words, if an ER is inundated by colds, the doctors and PA’s and NP’s that are treating the colds are not treating the guy with stomach pain that has an appendicitis.

Hospitals are for medical emergencies. The reason that hospitals are so expensive and how they can justify the cost of their care is that when it comes to life and death, the price is not negotiable. If I were having a heart attack or a stroke, time is precious. I wouldn’t be haggling with a hospital representative about how much aspirin is in the waiting room. I’d want to be in a cath lab or getting TPA as quickly as possible as this can possibly affect outcome. Some true emergencies that I would suggest visiting an ER for are acute shortness of breath and breathing difficulties, chest pains, and stroke symptoms. Obviously, if a patient is sent to the ER by their primary care doctor or upon the recommendation of a paramedic, they shouldn’t hesitate. Most other things can be typically managed in an outpatient facility, like a primary care office or an urgent care center.

Janet, like many other patients, believe that their health is priceless, that there is no cost. Unfortunately, this is not the case and the cost of a simple over the counter medication has a premium when it is administered in a hospital setting. Insurance companies have the cost down to a science. When Janet gets the bill, I hope she comes to understand the difference between the cost and the value of her health and doesn’t feel as if she got robbed.

Post by: Dr. Juan Borja
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