Op Ed: Put Patients Ahead of Profits

I run a small solo medical practice in Kalispell, Montana. Being of the old-school opinion that quality care requires quality time spent, my patients have time to share with me their many concerns. That sharing periodically includes exorbitant medical bills received from a hospital visit or outpatient specialist visit. The billing is usually the same format because these specialists almost all work for the local hospital, and many hospitals and clinics have merged into one entity that serves more or less as a monopoly. Most patients have nowhere else to go.

Many patients decline needed specialty care because they can't afford the deductible. Others who agree to see the specialist often require months to pay off the bill, and they often rightfully question the dollar value of a ten or fifteen-minute visit when they don't think their needs were addressed. Other patients find that it is less expensive to get a procedure done out of state, even taking into consideration the cost of the flight. How can there be vastly different costs for medical care based solely on the medical facility's ownership?

The high medical bills have myriad causes, and I focus herein on the one that allows for different charges for the same medical care because we have a legislative opportunity to change this one.

I have been aware for many years, that the additional facility fee Medicare pays for services of doctors who work for hospitals (their clinics called Hospital Outpatient Departments or HOPDs). That additional fee has made it profitable for hospitals to buy up independent physician practices. This drives up healthcare costs as it suppresses competition, creating monopolies of healthcare in some towns where patients have no options.

Legislation influenced by hospital lobbyists created this situation. Legislation designed for fairness can stop it. Fair billing reforms would bring a decrease in patient medical bills, save on health insurance premiums paid by small businesses and individuals who purchase their own insurance, and potentially prolong the lifespan of Medicare as one estimate is that Medicare would save more than $150 billion dollars.

The following bills have been introduced: Facilitating Accountability in Reimbursement Act (FAIR) HR 3417 in the House of Representatives and the Site-based Invoicing and Transparency Act (SITE) SB 1869 in the Senate. Both would help ensure far more affordable hospital billing.

Competition is almost always good for the consumer, in this case, the patient. This legislation is designed to remove one perverse incentive for hospitals to acquire private practices, paving the way for more small, personal, private systems that I believe have the capacity for providing the highest quality service. Such changes could save the American healthcare system billions, making treatments more affordable and accessible for everyone.

Please contact Senators Daines and Tester, and Representatives Zinke and Rosendale and ask them to vote YES for the SITE and FAIR Act.

Dr. Annie Bukacek has been a medical doctor for close to forty years, most spent in Montana. She currently practices internal medicine in Kalispell and serves on the Montana Public Service Commission.