Cost Shifting: Why two tablets of Tylenol cost $79 on your E.R. bill

by: Tom Deegan R.N.

As a journeyman nurse in the Southwest, I have worked at hospitals in California, Arizona, New Mexico and Colorado and witnessed a lot of waste. Not fraud, just doing things in a most expensive way. These costs of doing business are of a small order of magnitude compared to Big Pharma and the insurance industry; in fact, they have flown beneath the radar in the shadow of these headline issues for years. Nonetheless, a hundred billion here, a hundred billion there and soon you’re talking real money. Here are some common sense solutions to some of the more obvious black holes in American healthcare.

New ‘Emergency Departments’ on steroids are replacing what we once knew as ‘the ER” … at great expense. Justice seems particularly blind in the hospital setting, mistaking the ER for the calm and controlled setting of the surgical suite…and expecting the same standards to prevail. Litigation in this venue drives costs up exponentially for excessive testing, with the unintended consequence that we are creating 24/7 mini-Mayo Clinics to compete with the family doctor. So unlike the rest of staid and measured healthcare settings, the ER needs to be cloaked in Good Samaritan protection before we follow the lead of Old Europe into bankruptcy.

Hospital born and bred superbugs endanger the health of those who come to the hospital thinking they will be safe. Expecting a silver bullet any time now, for the seventeen years I have been in the business containment efforts have been shoddy. Methecillin-resistant Staph Aureus(MRSA), Vancomycin-resistant Enterococcus(VRE) and Clostridium difficile(C diff) stalk hospital hallways. On the Joint Commission website the mean cost of treating a MRSA patient is estimated at $35,367; the Center for Disease Control estimated 278,000 hospital acquired cases in 2005. That’s $9.8 billion in 2005, and MRSA has gotten more rampant since. We await antidotes from microbiologists at the National Institute of Health, but in the meantime we need to contain MRSA, VRE and C diff on the ground… probably in the great American tradition of engineering our way out of the problem. A suggestion: dedicated infection control hospital rooms and wings, financed by Federally guaranteed, locally issued, bonds.

When the candidates debated in 2008, Bill Richardson and John McCain brought up the subject of diabetes to their respective Party colleagues and the TV moderators. From the Southwest, both well understood how the overflow expense of Type II diabetes was tearing up their State’s budgets. The Congressional Budget Office calculates that direct cost of diabetes in the year 2007 to be $116 billion. The cost of the Iraq war in the same year was $125 billion. The war is over, but the annual expense of diabetes to the country keeps on coming. Type II diabetes is an acquired condition. A long term campaign to change the culture of lack of exercise and diets high in sugar and fats—like the New Frontier’s call to stop smoking—needs to be gotten underway to slow up this looming epidemic, so big an item in overall healthcare costs.

The Joint Commission is the inspector general for Medicare and Medicaid, yet with no real power. The most they can do to hospitals milking Medicare and delivering poor results to patients (as measured by ‘readmission’ rates, that is return patients within 30 days) is a slap on the wrist. What is needed is the authority and ability of the Joint Commission to act like the Federal Deposit Insurance Corporation. The FDIC replaced 157 managements of shoddy banks in 2007. They arrive Friday and transition out the old management by Monday. The Joint Commission–funded by a tithe on member hospitals similar to the FDIC tithe on member banks—can learn the same skill. We protect bank depositors but not patients.

Shifting hospital losses from unfunded mandates onto padded bills for those with insurance is no more than a tax on those who work hard and play by the rules. The expense of indigent and foreign nationals use of ER services is not spread across all taxpayers but rather falls on those carrying employer insurance…driving up premiums, soon to be $16,000 per year for a family of four (as measured by a recent Kaiser Permanente study). The polite name for this legerdemain is ‘cost-shifting’. This is why two Tylenol is invoiced on your copy of an ER visit at $79.

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P.S. I run this blog, Tom, is a friend of mine and was just featured on my foxla.com (here is the link) , so I will be re-posting articles from his blog, as well as his new book, Healthcare: A View From the Trenches, now available on kindle, it is reviewed as Reflections from a nurse on the front lines of a healthcare system in crisis. Tom Deegan, RN, shares personal stories from his long career providing hands-on care in the emergency room. This first-person account illustrates exactly why healthcare reform in community hospitals is the issue everyone should be talking about.

Two days in hospital last year cost me 30k. It is insane!

indeed james, it does seem insane until you see the big picture, and what their goal is. this is creeping fascism wrapped in a doctors coat. I have read parts of the health care bill, it seems impossible to find the entire text of the bill, and even more daunting to read in its entirety. there are things the medical community is attaching to your digital health file that most people arent aware of, I suggest you all get copies of your recent medical file and look it over. you may be surprised. It is my goal to write about things that I feel affect us all on a deep level, that the mainstream and even alternative media either under reports or mis reports. much love to you all, zen

My daughter had a pretty nasty fall off of her bike this past summer and after the emergency room visit, the bill was well over $1200.00. I do have insurance through my employer but it doesn't cover much. We still had to come up with about 3/4 of the bill. So... thankfully the hospital was kind enough to offer a payment plan of 21.00 dollars a month. It's a lot better than defaulting on a hospital debt.

But yes, it's still ridiculous what they charge these days. I hope I don't have to visit a hospital anytime soon but if I do, I'll opt out of the tylenol. I'll just bring in my own. I'll need it after the headache I'm going to have after I get the bill down the road ;)

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