I got two e-mails today asking for a comment on two recently publicized court cases. They both tie in to one common theme: It’s pretty clear where our medical system is headed – now it’s just a matter of the vehicle we’re going to use to get there. The one to the right is probably the most common one used to get to this destination.
One involved the California Supreme Court’s decision to bar emergency physicians from “balance billing” in the emergency department. Before this decision, there was a tension between emergency physicians who wanted to be paid fairly and insurers like United FraudCare that want to charge patients as much in premiums as possible while paying as little as possible to the medical providers so that they can keep earning their $45 billion per year and maintain their #35 ranking on the Fortune 500.
Emergency physicians refused to sign on with the insurers given the low compensation that was being offered. Then, when an insured patient was seen in the emergency department, the emergency physicians received some of their fee from the insurer and “billed” the patient for the “balance” of the fee – hence the term “balance billing.”
Now, the California Supreme Court’s decision states that even if the emergency physicians have no agreement with the insurer, they have to take what the insurer pays them as compensation. Emergency physicians can’t bill the patients for the “balance.” If the providers deem that the emergency physician’s services are worth 25 cents, that is what the physicians have to take. The physicians can try to get the remainder of their fee back from the insurers. Patients can’t get billed for it. Of course, if the insurers don’t pay the remainder, what recourse do physicians have? Nothing. Can’t stop treating the insurer’s patients. Federal EMTALA statutes state that emergency departments have to provide an evaluation and stabilizing treatment to EVERYONE. So if emergency physician groups don’t like it, they are stuck filing more lawsuits and paying more lawyers’ fees to try to get paid fairly.
The other case involved a rheumatologist who was forced to pay $400,000 because he allegedly “refused” to pay for a sign-language interpreter for a deaf patient. The physician was only making $49 per visit from Medicare, but would have to pay $150 to $200 per visit for a sign language interpreter. Instead, the physician used the patient’s family and used written notes to communicate with the patient. The patient sued the physician for discrimination under the Americans With Disabilities Act.
My opinion of both of these cases is that they are a good thing.
Kidding aside. I really am glad that they are happening.
Think about the effects of cases like these.
How many emergency physicians are going to want to work in California? I know I wouldn’t even think about a job offer there – knowing that I would likely be able to collect little to nothing for my services because the California Supreme Court held that some magical contract is created between all emergency physicians and all insurers and that those contract terms de facto provide insurers with unlimited bargaining power. Once service contracts run out with the hospitals, I foresee a lot of hospitals having a difficult time staffing their emergency departments. Care will suffer, people will die on waiting room floors, public outrage will force immediate change.
How many private practitioners are going to want to accept deaf patients into their practices? If we’re talking about providing translation in general, how many physicians will want to accept anyone that doesn’t speak English into their practices? Paying money out of your pocket for a translator so that patients can come to you for treatment is not economically sustainable. If the results of this case are widely disseminated, a lot of physicians who were previously “getting by” with writing things on paper will now have a disincentive to keep deaf patients in their practice. There’s absolutely no incentive to accept new deaf patients into physician practices. As more and more deaf patients are unable to find health care, public outrage will force immediate change.
With cases like this, we’ll get to the “change” our system needs a whole lot quicker. Of course, physicians will stop practicing, those seeking to enter the health care field will think twice about it, care will suffer, and, unfortunately, lots of people will become sicker and will die sooner in the process.
But we will get the change we need.
Hopefully there will still be physicians willing to practice once all of these changes occur.