We have not yet finished sounding the depths of the U.S. medical system’s dysfunction. On Saturday the NYT published a deep dive on the rise of “drive-by doctoring,” in which the primary doctor treating or operating on a patient calls in other doctors to assist him in the treatment. Often these assistants are out of the patient’s insurance network and are consulted without the patient’s knowledge. Patients who have negotiated rates with the in-network doctors on their case therefore are hit with large out-of-network charges they were not made aware of in advance. Moreover, these doctor assistants are often used in situations when a nurse practitioner would have done just as well—for no extra fee.
Sometimes these unexpected extra services are mandated by cash-hungry hospitals, who require primary doctors to request consults from colleagues even when those primary providers don’t believe such consults are necessary. This behavior is a response to cuts in reimbursements rates; since providers are paid less per procedure, both the providers themselves and the hospitals find ways of inflating the number of procedures performed. Even worse, the surprise charges are sometimes not even always confined to care actually given:
Mr. Sullivan, who had the emergency back surgery, discovered charges from more than 10 providers in the 48 hours after his operation. (The surgery involved simply trimming a herniated disk in his lower back.) He wrote to various doctors to dispute bills, saying, “I was admitted to Overlook Hospital from Nov. 26-27, 2013, and I have received numerous invoices for procedures that were never done, by physicians that never treated me”
He was puzzled by $679 in occupational therapy charges involving the delivery of a device to help him put on his socks, which he never used. He was irate about charges from a group of hospital-based primary care physicians from Inpatient Medical Associates, who visited him briefly once a day and billed close to $1,000 in out-of-network costs.
Whether surprise “drive-by doctoring” charges represent actual care given by out-of-network doctors, fabricated charges, or unnecessary services mandated by hospitals hungry for cash, the result is the same: Patients find themselves loaded down with bills they could not have anticipated and stuck with paying on them out-of-pocket. (Sometimes, however, insurers take pity on cheated customers, paying even for out-of-network providers).Rooting out these sorts of deceptive practices is always difficult, but upfront price transparency would be a key first step. If patients knew exactly how much they would be charged in total before a procedure began, including any out-of-network costs not immediately apparent, that would at least give them a better shot at navigating this dysfunctional system.