There are many reasons why a 99¢ box of kleenexes cost $30. One that has already been mentioned is the cost-shifting due to poor Medicare/Medicaid reimbursement. Another is the fact that hospitals, unlike physicians, radiology clinics, pharmacies, etc. cannot turn anyone away solely because of their inability, or even unwillingness, to pay.
One that really, really needs to mentioned, though, is the ineptitude in the billing office. I have worked in the billing offices of three of the major area hospitals.
So many medical providers pay their billing staff around $10 per hour and then wonder why their collections are in the toilet. Hello, you hire people whose applications and resumes are loaded with grammar and spelling errors, and you expect them to be able to handle complicated business and financial matters? If you want people to handle the job that can literally make or break you, you have to pay them to do that. LIke what is happening in the teaching profession - the good, competant people leave after a few years when they realize they can double their salaries by changing careers.
Hospitals are no different - in fact, they’re the worse offenders in the entire medical industry - next to billing services. Two of the chains I worked for had some of the lowest salaries in the industry. The incompentence and ineptitude started from the bottom and went all the way to the top. The software is in place to ensure that no bill or appeal goes past the contracted filing deadline, but the staff either ignores it or doesn’t know how to use it, and no one enforces compliance with policies and procedures or does more than cursory training. Since the salaries are so low very few experienced people are on staff, and of course promotions are made amongst this pool of inadequate employees. Of course you get to a the upper level management and they’re their because of their business degrees. They have never actually sat at a billing desk, so they don’t even understand the concept of maintaining an electronic tickler system to ensure nothing goes past filing deadline.
Then there are the staff that don’t even know how to read an Explanation of Benefits so either spend weeks appealing an item that has no basis for appeal, or converesely writing off an item that is appealable and should be appealed due to its large dollar amount.
The stuff that gets written off in these hospitals boggles the mind - and it’s stuff that’s getting written off only because of staff ineptitude and incompetence. We aren’t talking thousands here, folks, we’re talking millions.
But that was only at two of the hospitals - let me tell you about the third one. I was hired on a contract basis specifically to clean up old Medicare balances. OMG. First of all, one of the reasons the Medicare had gotten so bad was because the biller they hired to do it had no previous billing experience WHATSOEVER. And one of the reasons that they had to hire outside contractors to do the job was because NO ONE EVER ACTUALLY DID ANY WORK THERE. I am NOT joking. Let me describe the typical day of the typical biller at a certain smallish hospital in Fort Worth, Texas:
First you park right up against the building and run in and clock yourself in. Then you run back out to your car and move it to the employee parking lot three blocks away and walk back to the building. As you head to the billing office you poke your head into the volunteer office, the cashier’s office and the HIPAA office and greet and chat with any of the staff you happen to know. You do the same once you get to the billing office and make your way to your desk. Once you get to your desk you busy yourself with turning on your radio and checking your hair and makeup. Once you’re reasonably assured that everyone has arrived who’s going to, you make your daily breakfast trip to the cafeteria. You bring it back to your desk and while you’re eating your “chatting with” (read: shouting over the cubicles at) the rest of the staff.
Finally it’s about 11:00 and it’s time to get down to those personal phone calls you’ve been needing to make. You know, the important stuff like cancelling the DirecTV and planning your 6-year-old’s birthday party. When that’s finally all settled it’s time to go around from cubie to cubie and determine what everyone’s lunch plans are. Since there’s no good close places, and bringing your lunch is not “cool” (and anyway, the breakroom certainly wouldn’t hold everyone anyway, and it’s hot and smelly in there) you’re forced to take an extended lunch. No problem as long as there is someone who’s taking a later lunch or working through lunch (er, sitting through lunch because they need the overtime) becuase then they can actaully clock everyone else out about ½ hour after they leave. And, of course, as long as someone brings a cell phone so that if lunch is going to be more than 1½ hours they can call this same person and have them clock everyone back in. Then the lunch groups go to the closest exit and wait while the folks who have volunteered to drive go the three blocks to the car and come back and pick everyone up. This is reversed for the trip back, and of course it would be rude to leave the drivers to walk in the building all by themselves so again they wait by the closest exit.
Now it’s about 2:30 and you’re thinking maybe you should fire up your computer. Of course, you remember a goofy email you got that you want to send to everyone. Of course, you never really got the hang of Outlook because you never had any training on it and you crash your computer trying to send the email. So you call the unit secretary over, the one who also as absolutely no IT experience despite the fact that it is in her job description that she will maintain all the computers in the unit. So after 30 minutes of the pair of you tinkering around with a machine you know nothing about (while such gems are heard coming out of the cubie such as “Cookies? What’s that?”) the IT whiz decides you need a new machine and calls the REAL IT folks to bring one down. Y’all finish tinkering with the machine just in time because the birthday party is starting! A ½ hour later everyone makes it back to the desk just in time to hear that the group’s favorite song is playing to of course everyone has to get up and dance in the aisles. The end of the workday is near so of course now you have to prepare to leave your desk unattended overnight - sort through all the papers, mail, and charts that people have thrown in your inbox and put them in the pending box or another person’s inbox where they belong. Check your make-up for the drive home, turn off your desk light and radio, then pull your chair into the aisle to join everyone else to get up to speed on the latest gossip.
Then walk out to your car and pull up to the building and run in and clock yourself out, and chat with everyone on your way out about how tired you are from having worked all day.
This is NOT an exaggeration, or even a “composite”. I worked there 7 months and too many of those days I saw people who never once even turned their computers on.
The business office manager was completely clueless. Why? Becuase she never walked the floor of the office she was charged with managing. Why? Because if she did, someone might actually ask her a question, and since she had never managed a hospital business office before, she would be shown up for the fraud that she was.
And the powers that were kept wondering why the hospital was in so much financial trouble. They eventually sold it.
And this, my friends, is why your hospital must charge $30 for that 99¢ box of kleenexes.