Be Wary About the Business Side of Health Care--Editorial

By Anonymous

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It has been coming to our attention more and more: health care decisions are often propelled by business decisions, sometimes even by greed, and each of us better pay attention so that our personal health is not put at risk.

An episode of the television show “House M.D.” entitled “Pressure Cooker” follows day in the life of Dr. Lisa Cuddy, the CEO of the hospital. Part of the plot showed the negotiation with a huge health plan. Dr. Cuddy finally pressured them into paying 12 percent more for care provided to the patients at her hospital. It took her playing hardball and, along the way, the TV scriptwriters illustrated how the management of the health plan was making boatloads of money. For them, it wasn’t about supporting quality care, it was about maximizing profit.

In recent news, however, there was even more. Federal officials were exposing the multi-billion dollar profits of real-life health plans--in this case Anthem, in California--including how much they make in Medicare Advantage plans. All this, during our down economy and while millions of people have no health insurance at all.

Now one more news item: a company called Select Medical, a for-profit-company that has 40 “hospitals within hospitals” to provide long-term care for seriously ill patients, may well be taking the taxpayers to the cleaners while providing, at least in some cases, very poor quality care; care lapses that have, in some cases, led to death of the patients. In a New York Times, expose, Select has been shown to be making many millions on a loophole in Medicare payment rules. The rule allows general hospitals to transfer a patient when the Medicare reimbursement is running out. The transfer is often to a Select facility which may simply be on another floor of the same building. Medicare rules, as they stand now, allow Select to start billing again and Medicare will pay for up to 25 days more of long-term care. Crazy! And guess what? Curiously, Select most often discharges people on day 25, what they call “magic day,” but resists family and even physicians on discharging someone before that. Up to day 25 they make $3,000 a day per patient. After that they don’t get paid. One more item about Select, the father and son who run it reportedly each got paid $200 million last year.

Okay, so what does all this mean for you or your loved one? First, you have to know that money interests for someone else may be driving what tests and treatments and the length of hospitalization – and where – is recommended. You have to question things. Your interest is in making sure you get the safest and best care. What is offered to you, or even forcefully "suggested” may not be what’s best for you nor best for our dwindling Medicare funds. If you “smell a rat” or have questions you have to squawk.

Look, most providers and hospitals truly want to make you well or help you stay healthy as they navigate tough economic times, low reimbursements, and uncertainty about “health care reform.” But that doesn’t mean you should trust them or anyone providing care blindly. Be a smart shopper because whether you are dealing with a non-profit or for-profit health care organization, believe me, deep down: it’s to a greater or lesser degree, about the money.

Be wary and make sure you are getting what is best for you!

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