Valley Voices

After eye surgery, I see clearly now. It’s the hospital bills that are blurry.

When it comes to health care, education on costs and clarity of the billing process should be a priority.
When it comes to health care, education on costs and clarity of the billing process should be a priority. The Fresno Bee File

The health care system has saved my life but my only trust is in its dedication to delivering incomprehensible bills.

Promises of patient-friendly invoices quickened with the Affordable Care Act in 2010. But closed-door jawboning has resulted in what many view as the usual self-perpetuating flimflam.

To wit: “The government created the mess that we’re forced to use (hint: blame them). … If we become too public, our competitors will put us out of business. … The formula for what we charge is proprietary information (suspicion: there is no reward for clarity).”

Invoices are a Pandora’s Box of hieroglyphics and hierarchies culminating in “patient share … pay this amount.” There’s neither education nor empowerment in the drumbeat toward collection agencies. Ghosts still run the machine, which seemingly flaunts examples of excess.

Take the NYC Health + Hospitals corporation. The public health system cut nearly 500 management positions this year, saying it would save $60 million in fiscal year 2018.

“Today we’ve implemented a difficult but necessary action to help build a stronger, more agile and more stable public healthcare delivery system,” said Stanley Brezenoff, interim president and CEO, in Becker’s Hospital Review. “By restructuring and reducing unnecessary layers of management, we can better direct resources where we need them most — at the front line of patient care.”

So, until now, the resources were being squandered by layers of bureaucracy putting care was risk? We all pay for this doublespeak.

Executives know the price of everything but the value of nothing – save grandstanding. Why else would Daniel Snyder, CEO of Shreveport, Louisiana-based University Health System, try to one-up a Louisiana state senate hearing inquiring why his company hadn’t paid a $12 million debt for Louisiana State University physician services?

There’s not enough documentation to support the request, said he, before whipping out a $6.2 million check from his coat for said services.

So there, enjoy the half a loaf I’ve been carrying for lunch.

“If this is how you conduct business, the future doesn’t seem to be too bright,” replied a stunned Finance Chairman Sen. Eric LaFleur in Becker’s Hospital CEO newsletter.

Patients are jittery as they enter the sprawling boxes of concrete with jail-like windows. How do I get to the head of the line and out of here quickest – in good health?

We are compelled to present government identification, proof of insurance (sound like a traffic stop?), to sign and pre-pay (credit card would be ideal, I’m told, but is that a good idea?) and authorize things that supposedly shouldn’t occur but which I’ll never recall approving anyway.

I’m compelled to trust whatever caregiver is assigned to me – who changes every eight to 12 hours – that they will adhere to the same care plan and advocate for me as my condition changes. That’s a fragile, frightfully important task remanded to strangers when my physical and psychological faculties are unsteady.

Troubling, too, is how little caregivers know about the cost of services.

More than 60 percent of emergency medicine clinicians can’t accurately estimate the costs of care, according to a study in the Journal of the American Osteopathic Association.

That’s odd given that administrators expect doctors to stick to a formulary of medications and a defined storehouse of gear and tests that have been proven to cost-effectively get the job done.

Fiscally empowered doctors can involve patients in cost containment.

When told that as part of cataract surgery I could have lenses installed that would end reliance on eyeglasses – if I forked over an additional thousand dollars – I opted to keep my eyeglasses.

Given the punitive nature of billing, it’s no surprise that:

▪  A survey from Bankrate, a financial planning site, found that a quarter of 1,000 adults went without treatment because of cost.

▪  Nearly 70 percent of patients with hospital bills of $500 or less didn’t pay off their balance in 2016, up from 49 percent in 2014, according to the Healthcare Financial Management Association.

▪  Those who can fork out thousands a year can bypass insurance by buying concierge care – “me first” access to doctors and medical facilities.

Explaining a hospital bill ranks right up there with educating patients about lifestyle choices. They’ve been triaged out of the picture by politicians and providers as too costly, time consuming and raising more questions they don’t really want to answer.

John G. Taylor, a former Fresno Bee reporter and editor, is owner/operator of The JT Communications Company LLC. Write to him at