I woke up in a hospital room.
A nurse entered and leaned over me. Her name was Godslove and she was from Ghana. She was accompanied by Isabel, who had just joined the staff at Austin Heart Hospital. I instantly felt they were caring and capable. It had been that way with everyone since I checked in at 5:30 am.
That was July 20. I had just recovered from general anesthesia for a heart procedure.
This is a happy story. Until the end, it’s an affirmation of American healthcare and the amazing things that can be done with new technology and the wonders of skilled teamwork.
Discovering Atrial Fibrillation
But let’s start at the beginning. I was diagnosed with atrial fibrillation when I was 66. AFIB is one of the most common heart ailments. The older you get, the more likely you are to have it. According to the CDC, an estimated 12.1 million people will have it by 2030.
AFIB is a condition where your upper heart chambers lose their usual timing. Instead, they quiver at high speed. The result is inefficient movement of blood. That increases the odds of stroke, and possible death, from blood clots.
AFIB gives some people a feeling of impending doom. Others are unaware.
Me, I’ve been lucky. The condition was well controlled by a generic drug until this year.
Procedures and Cures
But I got Covid-19 in January. After that, I was in AFIB more each week, feeling tired and vulnerable. By July it was time for the next step, an ablation. The procedure starts with two catheters in your groin. They are moved up to your heart and, after careful electrical mapping, zap the errant heart tissue with heat or cold. Mine was a cryo-ablation.
Is the procedure a cure? In the broad statistics, no. If you have AFIB, it’s likely to recur. Early studies showed that about 50 percent of patients were back in AFIB within a year. More recent studies indicate longer relief for over 70 percent of patients.
Many patients have two ablations. Few have more, but it happens. One of my younger brothers has had five. One woman told me she has had nine.
Improving the Odds
Is there a way to improve the odds of success? Yes, research studies suggest that the more ablation procedures done at any given facility, the better the odds the procedure will be successful and avoid negative outcomes.
Experience counts.
So, if you’re going to have an ablation, have it done at a busy facility like Austin Heart Hospital. And have it done by an experienced doctor. Dr. David Kessler from the Texas Cardiac Arrhythmia group did my procedure. We had been meeting regularly for a decade. During that time, I became very confident in his ability and admired his range of knowledge. (He will be the first to admit, however, that he is utterly stumped by hospital billing.)
Before the procedure, my heart rate would randomly hit 150. That’s not good for a man approaching his 82ndbirthday.
Today, I walk briskly with a heart rate between 90 and 110.
And what about the cost?
The Hard Part
That’s the part that I, like Dr. Kessler, simply don’t understand. It gives me more fear for our medical future than atrial fibrillation ever did.
My Humana Medicare Advantage plan copay was $50. In patient expenses, that’s like winning the Texas Lottery.
But my July statement from Humana told me the hospital had billed Humana $318,974.
Seeing that figure took me back to the late 1970s. I was business editor and columnist at the Boston Herald American then. One of the “evergreen” stories on the Associated Press wire was a feature about the high cost of a hospital stay. It was always accompanied by a photograph of a jumbled computer print-out that stretched across an entire room.
So how much did Humana pay? $20,948.
Yes, you read that right: $20,948 on a $318,974 bill.
How could that be? Was it a fire sale on AFIB procedures in July, selling them at 94 percent off?
Nope. It was pricing as usual in the healthcare biz.
Meet the Villain
The villain here is called Chargemaster. Think of it as a dark monster, like something you never want to encounter while playing Doom or any of its many mutations. Chargemaster is a computer-based charge system of ultimate detail. It codes and prices every conceivable expense. Hospitals use it, mostly in self-defense, to deal with the different payment procedures of private insurance companies.
People on the administration side of the industry take it for granted. Seriously. They are not embarrassed by a billing and reimbursement system that has made millions of Americans so afraid of contact with healthcare costs that the billing system, in itself, has become a threat to public health.
Until the moment I saw that statement, my experience was all about the amazing care I had received. Since then, I haven’t been able to get the insanity of medical bookkeeping and billing out of my mind.
If you are on Medicare, as I am, you have little to fear. It’s a mixed bag if you have private health insurance. But it you are uninsured, you’re likely to receive the full Chargemaster bill. God help you. This is one of the reasons medical bills have been one of the most common causes of personal bankruptcy for decades.
Oh, by the way, according to the Kaiser Family Foundation, Texas has the honor of having more uninsured people than any other state – 18.4 percent.
The More You Learn, the Stranger It Gets
Is anything rational here?
Let’s consider some figures. According to a 2015 study, the 50 most expensive hospitals in the country billed an average of 10 times the Medicare allowed cost. In the same study, the average hospital billed at 3.4 times the Medicare allowed cost. A more recent study showed that the average hospital billed at 4.2 times costs.
Since healthcare now accounts for nearly 20 percent of GDP, if hospitals were paid what they bill, there would be no money for anything else.
So, we live in a society with amazing science and, arguably, the most advanced technology on the planet. But we can’t find the talent to make a functional bookkeeping system? That’s pretty sad.
Is there a solution here?
Sorry, not from me. I’m just grateful for a regular heart rate.
But surely, isn’t this important enough to do right?
Related columns:
Scott Burns, “Why it’s a good thing to live beyond age 75,” 11/08/2015 https://scottburns.com/why-its-a-good-thing-to-live-beyond-age-75/
Sources and References:
Steven Brill, “Bitter Pill: Why Medical Bills Are Killing Us,” Time magazine, 4/4/2013 https://time.com/198/bitter-pill-why-medical-bills-are-killing-us/
Centers for Disease Control and Prevention, “What is atrial fibrillation? (undated) https://www.cdc.gov/heartdisease/atrial_fibrillation.htm
Mitchell L. Zoler, PhD, “Higher AFib ablation volumes inked with better outcomes, MDedge, 5/09, 2019 https://www.mdedge.com/cardiology/article/200624/arrhythmias-ep/higher-afib-ablation-volumes-linked-better-outcomes
Ge Bai and Gerald F. Anderson, “Extreme Mark-Up: The Fifty US hospitals with the highest charge-to-cost ratios,” Health Affairs, 6/2015 https://www.healthaffairs.org/doi/10.1377/hlthaff.2014.1414
Kaiser Family Foundation, “Health Insurance Coverage of the Total Population,” 2019 https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Uninsured%22,%22sort%22:%22desc%22%7D
Kaiser Family Foundation Study
This information is distributed for education purposes, and it is not to be construed as an offer, solicitation, recommendation, or endorsement of any particular security, product, or service.
Photo: Photo by Pixabay
(c) A.M. Universal, 1997