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Opinion
What you need to know for 01/18/2017

Don’t faint, nobody pays these bills

Don’t faint, nobody pays these bills

Have you ever gotten a hospital bill listing items like “Band-Aid, $75” and “sterile supplies, $18,6

Have you ever gotten a hospital bill listing items like “Band-Aid, $75” and “sterile supplies, $18,695,” the whole thing adding up to more money than you expect to make in the next five years? And you almost had a heart attack till you got to the bottom and found out that your copay was just $50 so you could breathe again?

And have you ever wondered where those fantastic charges come from and how the devil anyone ever pays them who doesn’t have insurance?

Well, it happened to a woman recently who had a surgical procedure performed at Ellis Hospital in Schenectady and in the fullness of time received a statement for $57,698, which did not even include the charges of the surgeon and anesthesiologist but only of the hospital. Before she could have a heart attack she noted that her copay was a mere $75, so she survived the initial shock.

But she did wonder what it was all about, and so did I when she passed the statement along to me.

We especially wondered about the cost of the little metal implant that had been put in her shoulder to repair a rotator cuff, which was given as $47,120.

Well, after a deal of chasing around, I was finally informed by no less an authority than the chief financial officer of the hospital, Daniel Rinaldi, that that number was a simple mistake, burdened with an extra zero. The correct amount is $4,712.

It was a relief, since I envisioned myself someday down on my luck, with no insurance and with a faulty rotator cuff, having to sell my stamp collection if I ever wanted to play horseshoes again.

But I still wondered where even the $4,712 charge came from, since Rinaldi informed me the hospital got reimbursed only $801 for the implant and knew in advance that was all it would get. And if a patient didn’t have insurance, the charge would have been the same $801.

So what was the $4,712 all about? Why would that amount be on the bill even without the extra zero? What did it mean?

“It includes a variety of items,” Rinaldi said, “and is an indicator of today’s environment.”

It’s called the “published charge,” he instructed me, and “has no relevance to what we get paid.”

So why is it there?

“The history of that is the federal government has required that hospitals maintain this published price listing,” he said.

Take the “published” charge of $205.55 for “pharmacy” on this patient’s bill. That is a “traditional amount that is added that is proxy for getting that pill to the bedside,” he said, not very helpfully.

The billed cost of $2,449 for “sterile supply,” taking another example, “comes from listing every single thing the patient got … it reflects the cost of providing that care.”

The best I could make of all this is that a hospital’s pricing is similar to a grocery store’s. You buy an apple at Price Chopper, and you pay not just the cost of the apple itself but also a share of the cost of the employees’ benefits, the property taxes, the maintenance of the building. All the store’s overhead is factored in.

The problem is the hospital doesn’t get paid the full amount whereas the grocery store does.

The hospital gets just 17 percent of the “published” price of the implant.

Is there a formula that generates the “published” price? Do you plug in $801 and out comes $4,712?

I could not get a straight answer to that question.

Granted, the hospital buys the implant from a medical-supply house for something less than the $801 it gets reimbursed — Rinaldi wouldn’t tell me how much less — so it makes money on that part of the deal, but I don’t know if it makes enough to cover the implant’s rightful share of building maintenance and administrators’ salaries.

Rinaldi said the hospital makes money on some other areas, but, “We have a very small margin, less than 1 percent,” meaning less than 1 percent of what the hospital gets for taking care of patients is profit — or the nonprofit equivalent of profit.

He thinks the hospital gets a bad rap — “They think we’re gouging the public with these charges” — but I think the bad rap comes from the bogus statements and the fanciful charges that no one ever pays and no one is expected to pay.

Ballot joke

On the political front I note the Appellate Division has upheld a lower court’s ruling that makes a joke out of the Schenectady ballot in the coming election.

A joke because three candidates of the newly formed Alliance Party will not appear on that party’s line. The spaces where their names ought to appear will be left blank.

Why? Because state Election Law specifies if a candidate represents two or more established parties, meaning parties that got at least 50,000 votes in the last gubernatorial election, that candidate cannot appear on yet another line for an “independent organization” like the Alliance Party, which has no electoral history.

So Alliance Party founder Roger Hull, running for mayor, and his running mates Vince Riggi, Madrea Chaires and Jacqueline Hurd, will be on the Alliance Party line, since they have only one other line, or in Chaires’ case, none, but Peter Guidarelli, Rich Patierne and Phil Tiberio will not, since they are already on two other lines, Republican and either Conservative or Independence.

This means if you look at the ballot as it will be printed and you read across on the Alliance Party line it will appear that the party is fielding only four candidates, not seven.

It’s not a matter of preventing one candidate from having too many positions and thus hogging the ballot. Gary McCarthy, Democratic candidate for mayor, will have four lines, but they are established parties — Democratic, Conservative, Working Families, and Independence — so that’s OK under the law.

Guidarelli, Patierne and Tiberio are forbidden to have three lines because the third line is for a new party, even though they collected all the required signatures to get themselves on the ballot for that party.

If their running mates Hull, Riggi, Chaires and Hurd had succeeded in getting the endorsements of two of the established parties as they did then no one would appear on the Alliance Party line at all. All the party’s candidates would have just a little note appended to one of their other lines.

What would it take to correct this absurdity?

It would take the state Senate and Assembly to amend the Election Law. But having in mind that the Senate and the Assembly are controlled by Republicans and Democrats, you can figure for yourself what the odds are of their making the electoral process more hospitable to start-up parties.

Fat chance, ladies and gentlemen.

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