NYT: The Company Behind Many Surprise Emergency Room Bills

[Physiciancouple.com]

https://www.nytimes.com/2017/07/24/upshot/the-company-behind-many-surprise-emergency-room-bills.html

A couple of thoughts:

1. Historically the NYT has seemed incredibly anti-physician in their rhetoric/spin. It makes me wonder a little about this article right off the bat.

2. How much of the out of network billing practice by these large management companies (ER/anesthesia/etc) is intentional and how much is because they rely on locum tenems from out of the area who may or may not be contracted with regional insurance payers?

 

I had a recent post on my blog looking at a hypothetical scenario of a specialist physician (partner in physician owned practice) selling his/her practice to a large national management company. I wonder if this aggressive billing practice is how these companies plan to make back their initial investment (in addition to paying below market wages to physicians, overworking said physicians, etc).

 

[redsand]

I can't answer your question--I don't know the answer.  Also, non-EM doc here.

My thoughts are that this article did not describe whether patients Medicare and/or Medicaid get out-of-network bills that they are responsible for paying. Those payors cover a significant part of the population in the hospital system where I work (located in a medium-sized city with several hospital systems).  It would be interesting to know whether out-of-network billing applies to all people or just those with private insurance coverage/uninsured patients.

[VagabondMD]

Out of network "surprise" large bills make all docs look bad. So does popping in a hospital room to say hello to a patient or after a two minute discussion realizing that you have nothing to offer and presenting a bill for $200 (or whatever). When I encounter the latter, I shake hands, provide a business card, and ask them to call in the future if they think they might need me. I do NOT bill $200 (or anything) for a hi-and-goodbye.

I do not know the financials of the EM doc business described in the but I am going to guess that they are venture capital-backed and that part of the profit strategy is to have a high percent of out-of-network charges. Just speculation...

[The White Coat Investor]

Glad to see this article getting so much publicity. EmCare deserves every bit of the bad publicity they're getting out of this. We're using this article to demonstrate to our administrators how happy they should be they picked us (a small democratic group of docs) over EmCare a few years ago during our last contract scare.

Not only do the docs get hosed by this (and other) contract management groups, but the patients do too. The corporate practice of medicine is supposed to be illegal for a reason.

[Zaphod]

The White Coat Investor wrote:

Glad to see this article getting so much publicity. EmCare deserves every bit of the bad publicity they’re getting out of this. We’re using this article to demonstrate to our administrators how happy they should be they picked us (a small democratic group of docs) over EmCare a few years ago during our last contract scare.

Not only do the docs get hosed by this (and other) contract management groups, but the patients do too. The corporate practice of medicine is supposed to be illegal for a reason.

Click to expand...

The issue I get with reading it is that it makes it seem as if its the "docs of EmCare" who are the greedy ones. It would be great for someone to come out and discuss how theyre actually paid and if its not commensurate with this level of billing.

[Doctor Money Matters]

This is what is happening as more and more private groups are being bought out by private equity firms. Its happened in radiology, anesthesia, and now emergency medicine. These companies know that patients dont have a choice usually in the docs that see them from these specialties and so if they become out of network, bills can sky rocket.  Most physicians have ethics that prevent them from this behavior. Not all though as there are hand surgeons in my city that take call for most ERs but remain out of network and then bill insane fees to the unsuspecting patient.

Ultimately this gets linked to the physician and the hospital and not the company. Its much like insurance, you blame who you see involved in care and not the entity that allows this to happen.

[Strider_91]

The way this reads it makes the physicians look like the greedy people who get paid more when they bill out of network but in reality they are paid hourly and the shareholders and administrators get rich. I read this article and understand how people can tell me not to go into medicine. I hope with all my heart that physician run groups can remain in the Biz, or that some corporate groups just don't suck this much. I have little faith in the retiring physicians choosing not to sell their younger brethren out for their benefit though. The history of other professions shows that older generations are more than willing to make it more difficult for the next generation. It's not their problem.

[VagabondMD]

Our radiology hospital contract requires us to participate in the major insurance providers in our market. If we do not, it is grounds for termination of the contract.

At least I know know how the VC backed firm that offered to buy our group could make their profit.