Health Care: Solving surprise medical bills

Imagine you walk into a hospital for a planned procedure, for example a knee operation to be performed by an orthopedic surgeon. Before you scheduled the surgery, you did your due diligence and confirmed that the surgeon performing the procedure participated in your insurance plan, and that the hospital where you were having the surgery was also in-network.

You know that you will still owe hundreds or perhaps thousands of dollars (depending on the details of your insurance coverage or any deductible you need to meet), but you’re certain the costs are manageable and you’re prepared to pay the final amount.

The surgery goes well, and you begin your recovery. Then, several weeks later, you get a bill for the surgery that’s much, much more than you expected to pay—maybe even ten or twenty times what you expected to pay. How did this happen?

A new paper, Solving Surprise Medical Bills from the Schaeffer Initiative at the Brookings Center on Health Policy, takes a closer look at surprise medical bills in America—and how policymakers can protect patients from them.

You might be shocked to receive the bill, but you wouldn’t be alone. Over the past several years, an increasing number of Americans have been hit with surprise bills for medical care. Surprise medical bills result from providers (physicians, hospitals, out-patient facilities, laboratories, etc.) that patients reasonably assumed would be in-network, but actually are out-of-network, or when patients have no real choice over the network status of their provider.

These bills are sometimes the result of emergency situations. None of us, in an emergency, place a call our insurance company to make sure the ambulance we need or the hospital we’re brought to is in-network. Yet you can still be liable for the astronomical bills that result.

Other times, patients are billed by out-of-network providers, such as an anesthesiologist, even though patients did everything they reasonably could to remain in-network for a planned medical procedure. As a result, patients incur much higher charges, which often exceed what insurance reimburses, sometimes are exorbitant, and can lead to financial distress.

There is bipartisan agreement that this problem exists, is increasing, and needs to be addressed. Important differences exist, however, on how the problem should be solved. Over a dozen states have enacted important protections and federal and state officials have proposed additional remedies, but these efforts are incomplete, and they pursue a variety of different strategies.

Read more: Solving surprise medical bills | Brookings Institution

Medical Industry: 3rd Top Cause of Death: Medical Errors - by Aby Haglage

A new study published in BMJ Tuesday suggests that if experts classified medical error as a disease, it would be the third leading cause of death in the United States.

Helmed by researchers at Johns Hopkins University, the paper estimates that medical errors cause 250,000 deaths a year, surpassing chronic lower respiratory diseases—the third leading cause of death—by more than 100,000. The authors blame limitations in death certificates for the lack of accurate data on the topic, and suggest the way fatalities are reported be revised.

Medical error is loosely defined as a “preventable adverse effect of care, whether or not it is evident or harmful to the patient.” The authors of the BMJ study cite specific types of error, which include “the use of a wrong plan,” “the failure of a planned action to be completed as intended,” and “an unintended act.”

It’s a phenomenon that’s virtually invisible in death statistics due to the United States reliance on what’s called the International Classification of Disease (ICD). Approved by the World Health Organization (WHO), it is used by 117 countries worldwide as a standard diagnostic tool for measuring mortality and morbidity statistics.

The system provides specific codes that correspond to causes of death, but leaves no room for physicians or others to denote a cause that resulted from a medical shortcoming. As a result of this limitation, there is no way to track how much medical error plays into the death rate worldwide.

Studies on the amount of deaths caused by medical error in the U.S., as a result, have been scant. The “seminal” study on the topic, as far as science is concerned, is a 1999 paper from the Institute of Medicine (IOM), which the authors call “limited and outdated.” The report estimates anywhere from 44,000 to 98,000 deaths per year from medical error.

Since 1999, several more studies on the topic have been released; one in 2008 suggested that as many as 400,000 people die a year from this cause. To update the current number, the researchers combined all of the studies since 1999 and performed a weighted analysis. The result: a mean rate of 251,454 deaths per year from medical error.

Martin A. Makary, the leader of the study and an oncologist at Johns Hopkins, attributes the lack of knowledge surrounding the issue to the CDC’s failure to create a system in which deaths due to medical care could be catalogued.

“Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums, such as a hospital’s internal root cause analysis committee or a department’s morbidity and mortality conference,” writes Makary. “These forums review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.”

The researchers give one example case of a death caused by medical error, that of a “young woman” who had successfully recovered from a transplant surgery. A few days after going home, she came back to the hospital with “non-specific symptoms.” At that point, doctors performed “extensive tests,” some of which the authors deem “unnecessary.”

When she returned days later, she was suffering from intra-abdominal hemorrhage and cardiopulmonary arrest. “An autopsy revealed that the needle inserted during the

pericardiocentesis grazed the liver causing a pseudoaneurysm that resulted in subsequent rupture and death,” the authors write. “The death certificate listed the cause of death as cardiovascular.”

Stories like these, says Makary, perfectly capture the problem with death statistics, and highlight the need for both the U.S. and the World Health Organization to pursue a better system.

Read more: 3rd Top Cause of Death: Medical Errors - The Daily Beast

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