JAMA Dermatol (formerly the Archived of Dermatology) is sent free to all dermatologists in the U.S. Each issue comes in a clear wrapper and an envelope advertising new drugs is affixed to the front page. A recent advert was for Rhofade, a topical cream that reduces the erythema associated with rosacea. Its effect lasts ~ 12 hours. Rhofade costs over $500 for a 30 gram tube with a GoodRX coupon. Sadly, the American Academy of Dermatology has allowed itself to be co-opted by industry.
Physicians who work for hospitals bill more for their services than do privately owned medical practices. Thus, insurers and patients pay more money when they see a doctor who is employed by a hospital. This is a dirty little practice that enriches hospitals and employed practitioners.
See:
When Hospitals Buy Doctors’ Offices, and Patient Fees Soar
Excerpts:
In the U.S., Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place.
The Obama administration is recommending a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients.
The administration’s proposal would essentially end that system of different prices for similar services. Medicare would pay the same for any visit, test or procedure offered by doctors who work in private practice and by those who work in off-campus practices that are owned by hospitals. Doctors who work in the hospital building could still be paid the higher hospital rate. But the free-standing practice that suddenly changes hands would not continue to be paid more.
In the U.S., Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place.
The Obama administration is recommending a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients.
The administration’s proposal would essentially end that system of different prices for similar services. Medicare would pay the same for any visit, test or procedure offered by doctors who work in private practice and by those who work in off-campus practices that are owned by hospitals. Doctors who work in the hospital building could still be paid the higher hospital rate. But the free-standing practice that suddenly changes hands would not continue to be paid more.
Abigail Zuger’s review thoughtful of Steven Brill’s “America’s Bitter Pill”
“Never sign up for a tour of the sausage factory, not if you want to keep eating sausage…Steven Brill has put together a comprehensive and suitably furious guide to the political landscape of American health care circa 2014 — a tour de force inspection of both sausage and factory.
The health business [is] totally awesome till someone goes and gets sick. Mr. Brill’s own perspective took a similar lurch when in the spring of 2014 he underwent repair of an aortic aneurysm, an expensive and complicated procedure. As a patient, he writes, “I was anything but the well-informed, tough consumer with lots of options that a robust free market counts on. I was a puddle.”
…the fatal flaw in market-based medical care: Patients and their relatives simply cannot be savvy shoppers. Their attentions are elsewhere.
The NY Times had a recent article on the cost of medical care. The price of care (especially in hospitals) can vary tremendously for the same procedure. In the case below the cost of a procedure varied by a factor of 122!!
"Hospital charges are all over the map: according to the report published Monday in the Archives of Internal Medicine, fees for a routine appendectomy in California can range from $1,500 to — in one extreme case — $182,955. Researchers found wide variations in charges even among appendectomy patients treated at the same hospital." See: "Confusion of Hospital Pricing" by Roni Caryn Rabin
Something is definitely wrong, brah! This is one CRAZY situation!
For the original article, see:
Hsia RY, et. al. Health Care as a "Market Good"? Appendicitis as a Case Study. Arch Intern Med. 2012 Apr 23