Cheryl Everett
Many, if not most, Americans feel frustrated with our health-care system, and especially with health-care pricing and billing.
In his book “The Price We Pay,” Dr. Marty Makary reports that for every 10 doctors, the average U.S. hospital has seven full-time equivalent staff working on billing and insurance.
The average patient is no match for that pricing and billing bureaucracy. One in five Americans now has medical debt in collections.
But a groundswell of healthcare professionals and patient advocates is sparking a movement to reform health care, starting with pricing and billing.
Reform, experts agree, will not happen in one fell swoop. Witness the never-ending controversy over Obamacare.
As the saying goes, successful change most often begins at the local level. Here in New Mexico, one aspiring local health-care reformer is Rio Rancho State Sen. Craig Brandt.
In the current legislative session, Brandt introduced Senate Bill 382: “Establishing requirements for hospital billing.” Brandt’s bill states: “A hospital shall ensure that all billing related to a single episode of care (in) that same hospital is made in a single statement that the hospital provides to the patient within 60 days of discharge.”
If third-party providers, such as surgery anesthesiologists, delay their billing to the hospital — which in turn delays that hospital’s billing to the patient — the deadline is 90 days from discharge.
Beyond that: “The hospital … shall forfeit the right to bill the patient” for any charges outstanding. The penalty for each violation is up to $500.
Brandt is not a medical practitioner or health-care bureaucrat.
A third-term state senator, he was moved to introduce his bill by personal experience and conversations with constituents. And he says, in characteristic no-nonsense terms, “If you haven’t got something to hide, you should be for it.”
As a former hospital program manager, I shudder at the uncompromising simplicity. Hospitals have no control over third-party billing, short of refusing to pay late billers.
One round of that tactic, and the hospital would find itself bereft of emergency physicians, radiologists and other supporting cast.
Brandt acknowledges the dilemma, but insists that direct action will “force the industry to come to the table” and negotiate terms that better serve the patient. But “the industry” is fragmented, and hospitals are only the middle party in the billing process.
I know “it’s complicated” is no excuse for inaction. Health-care reform is the wave of the future.
Remember that when thousands of Americans protested the war in Vietnam, few guessed that the ensuing anti-war protest movement would eventually bring the war to a halt. Can we bring predatory medical billing to a halt?
The ultimate fate of Brandt’s bill was unknown at press time. But the effort to tackle medical billing is admirable.
Maybe similar “small steps” could snowball into an avalanche of health-care reforms. In the uni-gender language of a bygone era, “One small step for man, one giant leap for mankind”?
(Cheryl Everett is a Rio Rancho resident and former city councilor.)
