Friday, October 7, 2016

About that $39.35 charge for holding a newborn baby

By now you've probably heard about the hospital that charged $39.35 for a woman who just had a cesarean section to hold her baby.

The baby's father posted a copy of the bill on Reddit, and it drew over 11,800 comments. The story was also widely circulated on Twitter.

At least one labor and delivery nurse on Reddit and a spokesperson for Utah Valley Hospital where the baby was born stated that the charge was not for holding the baby, but rather it was because an extra nurse had to be brought into the room to watch the baby while the first nurse took care of the mother.

I'm not buying it. The only way to justify charging for the presence of a second nurse would be if she had to be called in from home. If the nurse was already in the hospital which I'm sure she was, the five or so minutes that it would take for her to stand by while the mother holds the baby would surely not take her away from the routine duties of a labor and delivery nurse.

This is especially true for Utah Valley Hospital which delivers about 3600 babies per year. Only about 30% of them or about three per day are born by cesarean section.

And who says a second nurse is even required? Most cesarean sections are performed under epidural or spinal anesthesia. The mothers are awake and perfectly capable of holding a newborn child. An anesthesiologist or nurse anesthetist is always in the room and is primarily responsible for caring for the mother anyway.

Like most hospital charges, the $39.35 figure appears to be the product of some bean counter's imagination. Why $39.35? Why not $39.95 or $68.87?

Apparently Intermountain Healthcare (a system which includes Utah Valley Hospital) has some other interesting billing practices. This is what one Reddit commenter had to say:

Hey, I know this world: we had to pay $700 for our son to stay in my wife's room. Here, I'll explain: my wife was billed $700 per night after her c-section, and my son was also billed $700 per night for his room.

Here's the kicker: they shared the same room!! So, I thought it was a mistake, right? So I called the horrible people at Intermountain Healthcare to point out that they had billed two charges for the same room. They're
[sic] response? "We bill each patient for the full room charge." Yep, they billed my wife $700 for her room, and my baby $700 for the same room. They also doubled the nurse charges (even though, again, my baby didn't have his own nurses.)

He refused to pay, and the bill was sent to a collection agency.

Congratulations on the birth of your son.


Anonymous said...

What makes me FURIOUS about this is that the money goes to pay for ADMIN. NOT the doctors, nurses, etc. who provide the care.


Dr Umesh Bilagi said...

Because of few people our medical is getting bad name

Skeptical Scalpel said...

I don't know how the money could be given to the nurse in this scenario. He would be a salaried employee and not entitled to any extra pay. The hospital shouldn't have charged for this anyway.

I agree that this sort of thing gives medicine a bad name.

PGYx said...

Full disclosure: I'm a doctor and totally sick of our bloated medical system.

I'm all for reducing upper management pay, but I also think we need to remember the incredibly high overhead hospitals have. People often think that the services they got were worth less than the [insurance negotiated] rate and that they should get the bulk price on each medication.

We forget hospitals still have to buy/ maintain $$$ equipment and buy expensive disposable supplies in addition to paying huge electric bills, admin salaries, nursing aides, custodial staff etc. The inflated cost for an aspirin, for example, helps cover some of this. Do you expect the janitor to donate his services? I once worked for a community hospital that requested post-tax donations from staff to cover the cost of equipment. HA!

If we want to lower medical costs, we need to reduce overhead costs and upper management salaries.

Skeptical Scalpel said...

I agree with most of your points. However, I have to laugh when hospitals cry poor. If they are so impecunious, why do they spend so much money on advertising which has ben shown to be ineffective []? How can they afford to open gleaming new towers and annexes and purchase numerous properties in their neighborhoods?

William Reichert said...

This discussion aside, I hope you had a nice trip to Ireland.
Did you have any discussions about Irish / American differences in
medical care /cost with the natives?

Chris said...

I think you're right that all they had to do was grab a nurse who was already present in the hospital, i.e. there nurse was not called in from home. But I think from an admin standpoint, whenever the nurse is somewhere doing something (from giving a flu shot in the ER to standing in a room with a newborn), the hospital needs to be billing for something. A nurse is never paid in a direct way related to the procedures that they take part in, but rather are a tool of the hospital to create billable encounters.

All I'm trying to say is this is a way for the hospital to make up for the extra nurse's lost time that would have been spent doing other important procedures somewhere in the hospital (that the hospital would be billing and getting money for).

Skeptical Scalpel said...

Chris, you may be right, but here's what I think. I don't know how long the skin-to-skin session takes, but if it's 10 minutes, I doubt if the nurse was even missed from her usual post. If it's longer, then maybe someone else had to cover something for her, but still no actual money was spent so I don't see why the hospital deserves to be paid for that.

Here's an example of a similar situation. Sometimes a sick patient needs to go off the floor for an x-ray with a nurse accompanying. It might take 30 to 45 minutes, and another nurse has to cover the other patients of the nurse going to x-ray. It happens all the time. I don't think most hospitals charge for that activity.

Skeptical Scalpel said...

William, yes it was a great trip. Ireland is a wonderful country. I had lunch with a surgeon friend who gave me a tour of the Royal College of Surgeons in Dublin. It's a fantastic old building. We did discuss some of the differences in our systems. They seem fairly satisfied with theirs.

Anonymous said...

Looking forward to the Ireland trip blogs.

Skeptical Scalpel said...

Anon, I may have something for you soon.

Cutter said...

Perhaps he should be grateful that he wasn't also billed for staying in the room with his wife and child...

Skeptical Scalpel said...

Yes, they could have charged him for every minute he spent in the room even if he didn't spend the night.

Anonymous said...

MS4 here - Last year on OB/Gyn I was in a largely surgical OB rotation (MFM). We did at least 3 CS's a day. Every time they did skin to skin. The way they managed this - the nurse and or peds team took the baby from me (the med student) and did an initial exam. Then they carried the baby approximately 6 feet to the mom and stood there, spotting the baby. Then when mom was done they walked the baby 6 feet back. No extra personnel was called in. The exact people who were there anyway were capable of walking a little bit. Which makes sense since ORs don't typically accommodate staff with mobility issues. ... Not sure where the $40 cost comes in during this scenario.

Anonymous said...

My sister-in-law delivered and did the whole "room-in" thing that hospitals encourage. Her baby spent the entire 24 hours or so in the room with the mom. They had a $6K!!! nursery charge. She called the hospital to understand this since they didn't use the nursery. The charge was for the availability of the nursery!? ... I am sure the ICU was available if she had had a post-partum hemorrhage. Should they be charged for that? ... I am currently well, breathing on my own, circulating my own blood. I can't imagine what charges I am accruing for the availability of advanced life support services in my community. Wow!

Skeptical Scalpel said...

Thank you both anons for your excellent comments. Anon 1 confirms that it is possible to accomplish skin-to-skin with available personnel. No extra help is needed.

Anon 2, that is a great story. I guess I am racking up charges at my local hospital's coronary unit with stands ready if I have an MI.

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