My husband recently had a series of tests done to rule out any significant issues related to abdominal pain. Within a week, we received bills that ranged from $65 to $2,200 for an MRI. We hadn’t yet met our annual deductible, so we were responsible for much of the costs. We’re both healthy and so have a robust balance in our health savings account. Our only worry was waiting to find out what was causing him pain.
But we wondered, how do people not as lucky as us handle these situations?
Reporting on the industry has given me new insight on what it takes to operate hospitals, health systems and physician practices. I understand that the lower the margin, the harder it is to fulfill the mission of healthcare.
However, there’s no denying that while reimbursement has tightened and costs have gone up (in part by the industry’s own doing), a sizable portion of the industry is doing well. There are about 1,100 hospitals or groups of hospitals reporting double-digit margins on their Medicare cost reports, according to Modern Healthcare Metrics. And salaries among not-for-profit executives are through the roof, as reporter Alex Kacik detailed in our last issue.
Meanwhile, the average patient, often saddled with debt and increased costs of living, is struggling more each year.
That’s why recent news coming out of Memphis, Tenn., troubled me. A local reporter there noticed that defendants appearing in county court were regularly identified as employees of Methodist Le Bonheur Healthcare.
Working with ProPublica, the reporter analyzed court records and found that from 2014 to 2018, Methodist filed more than 8,300 lawsuits against patients who owed money—many of them their own employees whose wages were garnished as a result. According to ProPublica, a Methodist employee in May was ordered to pay $100 a month to settle a $5,400 debt that included the cost of delivering her child. In her sworn affidavit, the employee said her checking account balance was less than $4.
Adding insult to that injury was the fact that Methodist’s wages lag behind other large employers in Memphis. While other local healthcare and municipal employers pay a $15 minimum wage, Methodist’s lowest-paid workers get $10 an hour.
It took about a month for doctors to diagnose my husband. He was sometimes doubled over in pain and we were warned it could be an autoimmune disorder or worse, cancer. Test after test, we never hesitated to hand over our HSA card, grateful we didn’t have to wait to cross one more issue off the list. Imagine the anxiety that might drive people to forgo care because they can’t afford it.
That should make hospitals consider how hard to push patients. Atlanta-based Piedmont Health is requiring 25% of the cost of non-emergent care to be paid upfront if a patient is in a high- deductible plan or pays out of pocket. The system says it will work with patients to make sure they’re not bypassing important care.
Patients sign agreements promising to pay for services rendered. But with growing evidence of prices being often arbitrarily set at unreasonable amounts, the plight of the average American is going unnoticed even by the people who espouse the mission of caring for the “whole” person.
The stress of owing money factored into Mary Washington Healthcare’s debt collection strategy.
Last month, the safety-net hospital in Fredericksburg, Va., announced it would stop suing patients to collect on unpaid bills. In a news release, system officials said it was in their community’s best interest to suspend the practice.
By the time my husband was finally diagnosed—with lactose intolerance—we owed nearly $3,000. I wonder had we not been able to so easily pay, if we would have been given as many costly options. My hope is that in the continued effort to consider each patient as a whole, providers take into account the role medical debt, and the resulting stress, plays in making their patients unhealthy.