Medical Costs Have Soared
MedPac estimated that reducing rates for these hospital outpatient facilities for cardiac imaging services alone would reduce beneficiary cost sharing and program spending by $ 500 million in just one year . MedPac also found that Medicare ’ s payments for a 15-minute evaluation and management visit by a physician were 80-percent higher in hospital outpatient departments than in freestanding physician offices . It estimated that facility fees for evaluation and management visits could add $ 2 billion to Medicare ’ s annual spending by 2020 if current trends continue .
In the last few months our practice has provided services for patients , many of whom were not ours initially , who were ordered to have a stress test done by their physician but refused because they could not afford it –– echocardiograms ( ultrasounds of the heart ) for $ 3,000.00 .
The current system also can leave elderly patients liable for a heftier chunk of the bill . The commission noted that in 2011 Medicare paid doctors $ 68.97 for a 15-minute office visit , of which the patient was responsible for a co-payment of $ 13.79 . For that same service in a hospital-owned medical practice , Medicare paid a total of $ 124.40 . In that case , the patient copayment was $ 24.88 .
What Can Patients Do To Better Protect Themselves from Unexpected Charges ? Ask in advance about your doctor ’ s hospital affiliation and billing practices . Ask if you will be charged for the physician ’ s services only , or for doctor ’ s and facilities / clinics fees ?
If your doctor does practice in a clinic that levies a hospital-facility fee , ask if the physician also works out of another office that might not involve the extra charge .
Check with your insurer about how your plan treats hospital-facility charges that stem from doctor-office visits or other care ( ancillaries ) that ’ s not delivered in a hospital .
Research urgent-care clinics in your area before you need one , so you know about their hospital affiliation , network status with your health plan , and billing practices .
Check if any urgent-care facility you select might bill you as if you ’ d been to an emergency room , and whether that would mean a higher out-of-pocket charge for you .
This article is a paid advertisement by the Heart Center of North Texas and its content doesn ’ t ’ necessarily reflect the views of LIVING WELL Magazine .
Why do hospitals and large health systems charge substantially more than independent physician practices , even for the same procedures ? One major reason is facility fees .
At the Heart Center of North Texas , we believe that care should be provided in the most efficient setting possible while maintaining quality of care . We also believe that patients should not have to pay significantly more for services provided in a physician clinic when that care is not dependent on the hospital facility and its associated technologies and on-campus staffing . We believe hospitals and hospital-owned and aligned physician practices should be transparent about their billing practices prior to providing care , especially if the patient or their insurance will be responsible for both the physician fees and facility or clinic fees . And lastly , we don ’ t believe that if the nature of the visit is identical , it shouldn ’ t cost the patient more money to visit a hospital-aligned physician group . Because if it truly did cost more , perhaps these services shouldn ’ t be provided in a hospital owned clinic .
www . heartcenterntx . com . See Advertisement on Page 31
Paid Advertisement
DENTON COUNTY Living Well Magazine | NOVEMBER / DECEMBER 2016
33