I have a busy morning so I just want to highlight a couple of interesting court rulings that have significant health policy implications:
The first is some bad news. A judge issued a temporary injunction against the FTC in their attempts to stop a hospital merger in Central Pennsylvania:
a federal judge declined Monday to temporarily block a union between Penn State Hershey Medical Center and PinnacleHealth System….
U.S. District Judge John Jones III rejected the FTC’s request for a preliminary injunction to stop the merger between Penn State Hershey, a 508-bed, not-for-profit health system in Dauphin County, and PinnacleHealth System, a not-for-profit, three-campus system with 607 beds, also in Dauphin County. He also slammed the FTC in his opinion for its opposition to such mergers in the current healthcare environment….
He wrote that the FTC too narrowly defined the systems’ geographic market because the agency didn’t account for the distances many of their patients travel to reach the hospitals. He also wrote that the FTC did not include enough hospitals in its definition of the market.
Jones also wrote that he found it “compelling” that the hospitals have already worked with central Pennsylvania’s two largest insurers, CBC and Highmark, to ensure their rates wouldn’t increase following a merger.
“In sum, we find based on the hours of testimony and thousands of pages of exhibits presented by the parties and considered by this court, that the FTC’s four-county ‘Harrisburg Area’ relevant geographic market is unrealistically narrow and does not assume the commercial realities faced by consumers in the region,” Jones wrote.
This is surprising as the combined Hershey/Pinnacle entity would have had 60% or more of the hospital beds in the FTC study region. That is a very concentrated hospital market. Furthermore, I am not too impressed that Hershey/Pinnacle has arrangements with two large insurers to keep prices stable. There are more than two insurers active in central Pennsylvania and the smaller insurers will be faced with an option to either pay Hershey/Pinnacle whatever they want or have a massive hole in their network. This decision will raise costs and create more blow to be inhaled off of hookers’ asses.
The other case is in Virginia:
A judge in Henry County Circuit Court has ruled that PHC-Martinsville Inc. (trading as Memorial Hospital of Martinsville & Henry County) is entitled to only one-fourth of the $111,115.37 the hospital billed Glenn Michael Dennis for services rendered when he was treated when he thought he was having a severe heart attack and feared he was going to die in May 2014.
Judge David V. Williams ruled that the hospital was entitled only to the amount the hospital would have received had Dennis pre-paid his bill as an uninsured patient….The hospital charged Dennis $111,115.37 for services he received during a brief stay there (he was discharged after two nights). Dennis had health insurance, and he and his health carrier have paid the hospital $27,254.95, according to Williams’ ruling….Dennis denied that a contract existed, because he signed the consent for services and financial responsibility form while he was lying upon a gurney in the hospital’s emergency room suffering from what he thought was a heart attack; that it was forced upon him by the hospital; that he was in extreme distress and unable to know or legally comprehend the meaning of the documents he signed; and he had no choice but to accept the terms….
“Dennis’s situation more closely resembles that of an uninsured patient, as Dennis’s insurance was not recognized by the hospital. A similarly situated person could have negotiated for services to be performed at a cost of $27,778.84, and the hospital would have agreed to that amount. Dennis owes the Hospital $523.89, the difference between the reasonable value for the services provided and what he has already paid the hospital….
If this logic survives appeal, this is a big deal. Hospitals and providers bill the moon as the vast majority of time it is settled at a contracted rate that is far less than the ask. However when there is an uninsured or insured but of of network patient, the moon is an opening bid. Pricing is not transparent, it is not fair, and there is a massive power differential between the hospital and someone who thinks they are in acute distress and has no good way to bargain as their lives may be on the line. Some states are dealing with out of network surprise billing and balance billing changes with arbitration between insurers and provivders while this template of deeming uninsured patients to be cash-pay patients might be simpler and more transparent. It would have the benefit of making pricing slightly more connected to reality.
I’ve known this is true for many years now. A bill that is routinely settled by an insurance company for 1/2 or less will be charged 100% to anyone paying cash (no insurance).
So, we take the people who are too poor to afford health insurance and crush them into the ground. The hospitals will take their house, their car, and everything they own to get that 100%.
Well the second one hits close to home after I had a complication from a routine procedure and ended up being treated in a hospital three hours away by a team of specialists.
Having a rare blood disorder will do that. I have no idea what I signed or how much it will cost but I’m alive!
@MomSense: Your situation and that of the man in the second case RM outlined above are perfect illustrations of why it’s illogical and cruel to treat healthcare as a commodity. People in distress are in no position to haggle.
If the hospital does give you their menu of services, you wouldn’t know how to pick and there are no prices listed.
I guess I’m lucky to be off the the VA this morning.
@MomSense: True. And even if you call in, study your benefits handbook and try to get your ducks in a row, sometimes you get a curve ball. I got stuck with an unexpected $2K bill recently for medical services that turned out not to be covered after all. Luckily for me, I can handle an unexpected bill without going broke or hungry. Many folks can’t.
@raven: Yep. You have socialized medicine, you lucky Dawg!
“Please do not ask for substitutions, or you may die.”
@Betty Cracker: @RSA:
I couldn’t really think about it. And now I’m too tired so I’m going to wait and sort it out later. I did go to my hospital and they transferred me so who knows what that means for pre approval and all the other fine print requirements. They were waiting for me with a team of specialists but I responded well and didn’t need the OR! In the past when this kind of thing happened everyone reduced or cut their bills because it seems all the doctors have some horror story of losing someone like me to a nose bleed in the ER when they were residents. There also seems to be an element of “cool I’ve only read about this before”.
But the fact is that you can’t really make an informed decision when you are in crisis.
@Betty Cracker: actually I have BCBS, I get hearing aids and glasses here. Oh, big sign, no guns!
@MomSense: I’m glad things worked out, and good luck for the future. (My answer was more flippant than I actually feel about healthcare.)
Snarki, child of Loki
I suppose that one could negotiate the settlement of the hospital charges with a gun pressed to the hospital CEOs head. That would provide a certain ‘parity’, would it not?
I’m a big fan of gallows humor. When I get the bill I may offer my first born.
When I had a bad asthma attack which resulted in hospitalization in Minnesota back in ’96, I received a whopping $12,000 bill. Thankfully, I was a Canadian citizen back then so between Canadian insurance and my Dad’s workplace, the bill was covered. It is insane how too many Americans are routinely bankrupted by medical costs.
All that that you need to know about the antitrust ruling:
“John Edward Jones III (born June 13, 1955) is an American lawyer and jurist from the U.S. state of Pennsylvania. A Republican, Jones was appointed by President George W. Bush as federal judge..”
@bcw: I’ll jump in with a partial defense–Judge Jones found for the plaintiffs in Kitzmiller v. Dover.
@Betty Cracker: In and out, hearing test and she said it hasn’t changed but the VA criteria has and she ordered a new one for my right ear!
@raven: That was quick!
Wow, shock polls from Q-pac. Trump down only one in Florida, up four (!!) in Ohio, down one in Pennsylvania! Wow, Democrats should be getting nervous!
@Betty Cracker: I had an 8am and was out in 20 minutes. The waiting room was full by the time I left. They staff is great but it is a sad ass place and nothing compared to the big VA hospital in Augusta.
Most people can’t make an informed decision even when they’re given plenty of time to make up their minds. Medicine is a specialty run by highly trained experts, and even those experts don’t always get it right. People depend on their doctors to make a lot of decisions for them, and in that case they really can’t be expected to be able to behave like informed customers. The whole idea of shopping for care is ludicrous except perhaps for some kinds of completely elective procedures.
@Raven: The big sign is for those armed guys with macular degeneration.
@Ruviana: yes, I stereotyped, Jones isn’t a ideologue.
pseudonymous in nc
And as predicted, Right To Shite becomes a INFINITE CORPORATE TRUMP troll.
Fuck off and eat some shit pie.
@pseudonymous in nc:
Just stating the facts. Still #StrictlyNeutral until I see some talk on entitlements from Trump, and he needs to make nice with Ryan. Otherwise I’m for #TakeItToTheHouse #ThirdParty #NeverHillary #NeverTrump
You don’t need a rare blood disorder to get confused.
I had a cough that wasn’t going away. Went to my nearest urgent care clinic one Saturday in January.
They checked my insurance and said I was covered. I’m in a high deductible plan, so everything goes to the deductible first.
I figured the insurance discounts would be less than paying cash.
They billed the insurance almost double what the cash payment was. The insurance, for whatever reason, did not have any discounts with this provider.
I’m trying to sort this out and see if the provider will accept the cash rate. It’s a difference of $120, which isn’t going to break me either way, but even for minor things there’s no way to predict what sort of bills you’ll get stuck with.
@pseudonymous in nc: *sighs* Don’t feed the troll. Put up the Cleek’s Pie Filter and leave the rest to the mods.
@Ruviana: He also struck down Pennsylvania’s ban on same-sex marriage
Long ago my grandfather suffered a heart attack on a CTA platform in Chicago. The ambulance attendants demanded payment before transport so shaking with pain he wrote a check. He learned later, to his great pleasure, that his signature was so impaired his bank bounced the check.
@Tom D: wonder how an aggressive cfpb could go after contracts of adhesion like these