Intensive Expensive Care

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August 30, 2006

News

Expensive Care

How to run up a $17,000 hospital tab without actually

being sick.

By Roger Downey

 

Most doctors are proud of the fact that they don't

know how much a

Q-Tip costs.

 

Recently, after a light meal at a lady friend's

accompanied by a bottle

of wine (for the two of us), I decided to drop by some

Capitol Hill

bars. At the first establishment I dropped into, I

remember pausing near

the entrance to look up at a video screen. Next thing

I know, I'm being

interrogated by a number of hunky firefighters. Was I

conscious? Did I

remember my name? Had I recently partaken of amyl

nitrate or Viagra? A

plastic stretcher was deftly inserted beneath me, and

the next thing I

remember is the ceiling of the Swedish Hospital

emergency room rolling

by.

 

My doctor quickly determined my blood pressure to be

catastrophically

low, that I was anemic, and that my fainting had been

caused by

extensive internal bleeding, probably over several

days. If I left, he said, I

might die.

 

Such advice, coming from a peremptory man in green

scrubs, is hard to

ignore. So I allowed myself to be rolled upstairs to a

private room in

intensive care, where saline drips were attached to me

and a tab of

Demerol was proffered. The next morning, another

doctor appeared and

proposed an immediate endoscopy to find the source of

my blood loss. A few

hours and another Demerol later, he returned to tell

me that he'd found

no bleeding in my stomach—but if I'd drop by his

office in a few days,

he'd slip another mini-cam up my other end and attempt

to track it down

there.

 

By this time, I was feeling considerably better, and

insisted on being

discharged from the hospital. After a stiff tussle, I

was allowed to

leave. For days, I continued to feel in peak

condition—until the bills

began coming in. The total pre-insurance tab:

$17,214.74—which comes

to about $956.37 per hour. So I asked the hospital to

provide a

detailed accounting of my treatment. The stack of

papers I received made for

interesting, if sometimes disturbing, reading.

 

The first thing I learned was that I had not fainted

but suffered from

" TLC " —physician-speak for " temporary loss of

consciousness. " My blood

pressure on arrival was 90/50, which is very low. On

the other hand, my

heart rate sat at a relatively normal 80 and my

breathing rate a

similarly placid 14. More disturbing was the blood

they claimed to have found

in my stool.

 

Everything else that happened that evening depended on

that blood. Due

to its alleged seriousness, by the time I left the ER,

the meter stood

at $2,669 (including $426 for installing the saline

drip). The ER

doctor also sent me to intensive care ($4,500 per day)

instead of an

ordinary room ($1,600). I'll be interested to see what

accounts for the $2,900

difference, since the ICU services, apart from topping

off the already

installed drip, consisted of attaching a clip to one

of my index

fingers to monitor my blood oxygen saturation.

 

The rest of the bill? Lab tests ran around $2,650. The

squint into my

stomach cost $1,702—reasonable, I guess, though $436

for the little

single-use dingus that scraped up some tissue and

found nothing wrong

seems a little steep. The later colonoscopy that

showed no bleeding was

billed at $1,820. Everything else was, by comparison,

chump change, down

to the $44 for a " nutrition consult–IP " that I never

had.

 

Trouble is, the whole business was based on evidence

of blood in my

stool—and nobody had taken a stool sample from me

(it's the kind of

procedure you don't forget). Bottom line, I

fainted—maybe from the heat,

maybe for some other reason. On that basis, and

because my blood

pressure was low, I was given full-bore ICU treatment

for, it turns out, no

earthly medical reason.

 

Had an auto mechanic made a similar call leading to

similar unjustified

expense, he would not see a lot of cars passing

through his garage

portals once word got round. Doctors are different.

They need not concern

themselves with the cost of the measures they

recommend. Indeed, most of

them are proud of the fact that they don't know how

much a Q-Tip costs,

let alone a " disposable BX sterile forceps. " And their

expertise goes

largely unchallenged.

 

The patient, meanwhile, doesn't have an advocate by

his side as a

litigant has in court. And as long as physicians,

hospitals, and insurance

companies continue to play their intricate game of

absurdly high charges

tempered by equally absurd write-offs for each

enigmatic item, the

patient will never have the slightest idea what he's

paying for, let alone

whether he's gotten his money's worth or whether he

should have had the

procedure in the first place.

 

As I was leaving the hospital, the doctor who was

signing my hall pass

remarked shyly, " If you ever find out what actually

happened, let me

know. " I'd love to, Doc. But so far, I'm as in the

dark as you are.

 

rdowney

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