Methods Getting around Limits on Fees Challenged

By Kramon, Glenn | THE JOURNAL RECORD, April 4, 1989 | Go to article overview

Methods Getting around Limits on Fees Challenged


Kramon, Glenn, THE JOURNAL RECORD


Employers and the government are beginning to challenge methods some doctors and hospitals use to get around limits on fees.

The new billing practices of the health-care providers include itemizing bills and charging separately for services that were once automatically included in a single, lower price. They also include tailoring a diagnosis to justify a higher bill or charging for a costlier ``comprehensive'' examination instead of a ``limited'' office visit.

The practices are a response to increasingly tight limits on what insurers will pay.

To gain an advantage, both sides have been hiring consultants.

Some consultants teach doctors and hospitals how to increase their revenue and some teach insurers how to keep up with the doctors' and hospitals' billing techniques in an effort to slow surging health-care costs.

``It's a game,'' said Joseph B. Stamm, executive director of the New York County Health Services Review Organization, which works for both the government and private employers. ``We're trying to save money and they're trying to maximize revenue.''

Occasionally caught in the middle are the patients, who can be left with a large share of the bill in some disputes. In some cases, they have been sued by doctors seeking to collect the balance of bills not paid by insurance.

To be sure, much of the 9.1 percent increase in health expenditures expected in the United States this year, to a total of $590 billion, can be attributed to a rising demand for and wider availability of sometimes costly medical services. But at the same time, doctors and hospitals have been charging sharply higher rates.

While it is difficult to determine how much of the increase in health costs is due to billing practices, one expert in health economics, Dr. Gerard F. Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University, said the proportion could be about a third.

``The concern is that not only are more services being provided - some of them unnecessary or inappropriate - but also that physicians are better able to find ways to charge more for what they are doing,'' Anderson said. …

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