As a former emergency room physician, one of the saddest scenarios I encountered was patients coming in with crises that could have been prevented with routine medical care. It wasn’t uncommon to have patients with diabetes come in because they’d had to ration their insulin, or patients with other manageable conditions entering in crisis simply because they couldn’t afford the medication they’d been prescribed.
These situations aren’t unique — my husband, an internist, regularly recommends diagnostic tests for his patients, which they sometimes must refuse, just because they’re concerned about large hospital bills. It’s no secret that we’re facing a health care affordability crisis.
But what can be surprising are mysterious, added costs that appear on hospital bills for a wide range of procedures, many of them often routine. Hospitals are charging more for medical bills because a patient happened to see a doctor or get an infusion or undergo a scan at what hospitals consider “outpatient departments.” These locations may be a simple office, a freestanding diagnostic lab or any other site that may not be anywhere near a hospital. Yet hospitals are charging more just because they can, driving up costs for my patients, and essentially creating another barrier to care.
Thankfully, in December, the U.S. House took action on bipartisan legislation called the Lower Costs, More Transparency Act, which would help advance site-neutral payment reform, meaning patients would pay the same price when receiving the same health care services, whether at an independent office or a hospital-owned one. As Congress continues negotiations on health funding, physicians such as me urge them to include the provisions of the Lower Costs, More Transparency Act in their final package.
Inaction is not an option. A root cause of rising health care costs is the rapid pace of health care mergers and acquisitions, which have been surging in recent years. More than half of all physicians are now employed by hospitals and health systems. As a result of these mergers and buyouts, costs go up for patients by an average of 14 percent. For some procedures, the increase is far more. Office visits on average went up from $118 to $186, while the cost of an ultrasound doubled on average from $164 to $339. Biopsies went up $146 to $791, a five-fold hike.
Meanwhile, more Americans report having a hard time paying their medical bills and more people are getting sent to collections for medical debt in 2023 compared with a year ago. And tellingly, the number one source of medical debt is now office visits. And having insurance coverage almost means nothing, with insured patients now accounting for more than half of hospitals’ bad debt in 2022, up from just 10 percent in 2018.
The skyrocketing cost of health care forces my patients to make tough decisions. Pay the rent or keep up with treatment that has to be done at a so-called “hospital outpatient department.” Put food on the table or get a diagnostic test the physician ordered, but which is available at sites owned by a large hospital corporation.
No patient should have to make these impossible choices. No American should have to ration their care. Yet too many of them do.
As a physician, I know all too well what happens when patients put off care due to cost. Conditions that could be better managed early get worse, becoming more uncomfortable and painful for patients, as well as more expensive and difficult to treat. Too often, patients end up in the emergency room when they never would have had to had they gotten care earlier.
These tragedies are preventable, and Congress has the opportunity now to make that so. By passing the Lower Costs, More Transparency Act, or including similar provisions in their negotiations over health funding, they can help make hospital prices more transparent but also more fair. Congress can ensure that when a patient receives the same health care service at a hospital-owned office, they aren’t charged more just because of the name on the door.
These common sense reforms are important steps toward keeping health care costs in check. They put patients and families’ well-being ahead of corporate hospital profits. By removing another cost-related obstacle to care, these reforms can improve health and save lives — and that’s why Congress must act without delay.
Dr. Nita Schwartz is a palliative care and hospice medicine specialist in Carson Valley.The Nevada Independent welcomes informed, cogent rebuttals to opinion pieces such as this. Send them to [email protected].
