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.

Do doctors charge too much?

We all know that some doctors’ fees are excessive. I have blogged about this myself citing a neurosurgeon’s $117,000 charge for assisting on a case.

We also know that doctor bashing is a popular sport right now.

In an otherwise reasonable article about high-deductible health insurance on Vox.com, reporter Sarah Kliff’s second paragraph read as follows:

The bolded text was hyperlinked to a Washington Post piece about a study that showed wide variations in hospital charges for appendectomies in California. The study was not about physician fees. No matter how difficult the case was, no surgeon would ever have been paid $186,955 for performing an appendectomy.

Yesterday, I twice asked Ms. Kliff to please correct this grossly misleading paragraph. She acknowledged my request that evening, but as of 9 AM today, nothing had been changed.

Even if Ms. Kliff had correctly identified the hospitals as the culprits, using appendectomy as an example of why patients should shop for the lowest prices was a poor choice.

Nearly every patient with appendicitis does not know he has it until he has gone to an emergency room, seen an ED physician, and had some tests. I doubt most people in this situation would A) ask how much it’s going to cost to have an appendectomy and B) decide to go to another hospital for care. The fact is, hospitals are so secretive about their charges that a patient would be unable to comparison shop especially if the emergency department visit occurred outside of normal working hours.

Even trying to find out the charges for elective surgery remains difficult in 2015.

Physicians—particularly surgeons—have taken a lot of heat recently. We don’t need articles like this to inflame patients (and journalists) even more than they already are.

ADDENDUM 9:45 AM 10/15/15

The article was just changed. The bolded mistaken passage was corrected, but the next sentence (underlined in red) remains the same. Still blaming those "really expensive doctors."

What's in a name? Med schools sell to the highest bidder

The 12th oldest medical school in the United States, Jefferson Medical College, has just changed its name to Sydney Kimmel Medical College after Mr. Kimmel donated $110 million.

Declining tuition revenues (ha!) and the reluctance to refuse such a large donation were important factors in the renaming.

When I checked, I found that several other allopathic and osteopathic medical schools are named after benefactors. The oldest medical school in the country, at the University of Pennsylvania, changed its name to the Perelman School of Medicine in 2011.

Some of the names are at least related to medicine like the Frank H Netter MD School of Medicine at Quinnipiac University in Connecticut. Dr. Netter was a famous medical illustrator and author. There's also the Dr. Seuss Theodore Geisel School of Medicine at Dartmouth University.

Three years ago, I blogged about the increasingly forgettable names being attached to stadiums such as M & T Bank Stadium [aka Ravens Stadium at Camden Yards, PSINet Stadium, Ravens Stadium], O.com Coliseum [aka overstock.com Coliseum, Network Associates Coliseum, McAfee Coliseum, Oakland-Alameda County Coliseum], and Sun Life Stadium [aka Joe Robbie Stadium, Pro Player Park, Pro Player Stadium, Dolphin Stadium, Dolphins Stadium, and my favorite—Land Shark Stadium.]

How much money would it take to get a school to change its name to The Tostitos School of Medicine or Yahoo Medical College?

Taking a cue from all of this, I am willing to sell the naming rights to the Skeptical Scalpel blog for the right offer. Operators are standing by.

Performance goals for hospital CEOs discourage change

A big problem with changing the focus of healthcare in the United States is that hospital chief executive officers are incented to produce profits for their institutions.

This chart from Kaiser Health News shows that the goals for most of the CEOs of major hospitals and health systems are profits. Growth and more specifically, admissions growth, are also mentioned.

It also lists CEO compensation figures, which are quite impressive. In addition to their hefty salaries, most CEOs also command large performance bonuses based on meeting financial goals.

According to Becker's Hospital Review, CEO pay has risen over 4% per year since 2009 with an increase of 4.8% this year.

All this in the era of the $546 charge for 6 liters of saltwater and the $73,002 charge for an emergency department visit for a urinary tract infection.

If you were a hospital CEO, why would you want to emphasize preventive care and outpatient services when your bonus is tied to profits, admissions and growth?

Everyone is entitled to make a living. And for sure most doctors do very well. But doctors are being squeezed on many fronts—declining reimbursements, need to purchase expensive and time-sucking electronic medical records software, more ICD codes, rising overhead to name a few. They are being forced to sell their practices to hospitals. Once the majority of physicians become hospital employees, their incomes will no doubt be squeezed further.

The public is demanding more accountability and transparency from hospitals and more emphasis on keeping people well rather than treating the sick.

Yet those who run hospitals have no reason to stress wellness and every rea$on not to. Don't look for anything to change soon.