HA520 Unit 10 Discussion

GIVE YOUR PERSONAL OPINION TO Samantha Thompson  AND   
Benjamin Schortgen  

Samantha Thompson 

Hello All

As a group we decided to do Case Study 2 on Bayview Surgery.

Ethical issues are problematic and healthcare institution should be transparent with billing for services. In this scenario it is hard to say where the unethical move lies, the surgical center who quoted her or the insurance who has little to no interest in getting to the bottom of the issue. The billing process is a sensitive one that goes in the way of services being rendered prior to a bill being complete. This is to keep issues for arising with extra services being needed but not paid for. Many patient don’t understand the billing cycle and how it works in a hospital facility. With that being said, it doesn’t mean that there should be no conversation or explanation. Helping a patient to understand what they are facing for their financial future is so important to standard of care, but also letting them know that we can’t give them a quote is also our ethical responsibility.

Variables in this scenario have to be thought of as well. What if the surgery had not gone as planned and more services were needed? This could include having a reaction to anesthesia or excessive bleeding. These are situations we hope don’t happen but have to consider. What if this ended up not being an outpatient surgery and she had to be admitted to the hospital? The encounter has to be closed before the billing can be sent off. The keeps things cleaner and closes the margin of error. 

 Benjamin Schortgen 

Our group (CJJB Consulting) decided to review scenario 1

Jennifer Rivers, Joshua Pardue, Courtney Canty, and Benjamin Schortgen

The Merriam-Webster dictionary’s primary definition of “fair” is, “marked by impartiality and honesty : free from self-interest, prejudice, or favoritism” (Merriam-Webster 2019).  A healthcare organization uses national standards to bill for services using a wide variety of standards and practices.  What they choose to collect, however, can be based on contracted pricing, capitation, and insurance bundling. 

The government requires uniform charging but not payments and self-pay patients have no bargaining power when it comes to the payments collected (www.aha.org 2019). How CJJB consulting see this self-pay issue play out oftentimes is a bill being generated, and if a self-pay patient cannot afford the medical expenses, the charges are written off.

Legally, a not-for-profit organization must comply with government regulations and rules, in our opinion, this is unethical by the governing body, not the not-for-profit. Everyone wants “transparency” but in healthcare this remains difficult and convoluted.  The government requires a charge be generated, let’s say $1,000, but it reimburses the healthcare organization $400+ 6% for operating costs.  What entity can out bargain the United States government? Third party insurance companies have contracts pre-determined and let’s say they pay 77% of usual and customary +$20 for overhead.  This is still much less expensive than a self-pay patient who gets the full $1,000 bill after medical service is provided.

In this instance, if we were the ultimate authority on this, we would remove this government requirement of mandated pricing. Let hospitals charge what they want, but require they let people know up front what those costs are.  Competition in a market tends to drive prices down, not up, which can help in making services more affordable when self-pay patients are deciding how to move forward with their healthcare.

References:

Hospital Billing Explained: AHA. (n.d.). Retrieved December 20, 2019, from https://www.aha.org/factsheet/2015-03-18-hospital-billing-explained.

Fair. (n.d.). Retrieved December 20, 2019, from