Carlsbad Hospital’s High Rate of Lawsuits Against Patients | The Line


>>WELCOME TO THE LINE OPINION
PANEL. OUR GROUP OF FOUR PEOPLE WHO
HAVE ALL AGREED TO STUDY THE NEWS EACH WEEK AND SIT DOWN TO
OFFER THEIR INSIGHT. WE START WITH LAURA BEALS’
ARTICLE FOR THE NEW YORK TIMES IN WHICH SHE DETAILED CARLSBAD
MEDICAL CENTER’S PRACTICE OF SUING ITS PATIENTS, A LOT. SINCE 2015 THE TIMES FOUND THE
HOSPITAL FILED MORE THAN 3,000 LAWSUITS AND 500 ALREADY THIS
YEAR. JOINING US THIS WEEK, WE HAVE
TWO NEWS LINE REGULARS BOTH FAMILIAR FACES BUT NOW COMMITTED
TO MORE FREQUENT APPEARANCES, FORMER STATE SENATOR, DEDE
FELDMAN. ANOTHER REGULAR, FORMER STATE
SENATOR, DIANE SNYDER IS BACK WITH US. THEY ARE JOINED BY ED PEREA, A
LAWYER AND PUBLIC SAFETY EXPERT AND WE ARE PLEASED TO HAVE JULIE
ANN GRIMM EDITOR OF THE SANTA FE REPORTER. DEDE, YOU WERE THE ONE WHO PUT
THIS ON OUR RADAR. THIS STORY WAS SHOCKING. I MEAN, YOU’RE TALKING FOLKS
THAT HAVE, I WOULD SAY, MEDICAL BILLS THAT ARE NOT HUNDREDS OF
THOUSANDS OF DOLLARS AT FIRST BUT THEY BECOME THAT AS THEY GET
SUED ENDLESSLY OVER AND OVER. WHAT IS THE DEAL HERE? WHY ARE WE SUING SO MANY PEOPLE
IN NEW MEXICO WHO CLEARLY DON’T HAVE THE MEANS TO PAY? WHAT IS THE ANGLE HERE FOR THIS
HOSPITAL AND OTHERS LIKE IT?>>THE HOSPITALS ARE TRYING TO
SURVIVE. THEY ARE USING — AND, OF
COURSE, THE DEDUCTIBLES AND CO-PAYS HAVE GONE UP. THERE IS STILL A LOT OF
UNINSURED PEOPLE OUT THERE IN RURAL NEW MEXICO AND THE
HOSPITALS ARE THE ONLY GAMES IN TOWN IN PLACES LIKE CARLSBAD AND
PORTALES AND ROSWELL, TO SOME DEGREE.>>SO, YOU KNOW, THEY ARE
SHIFTING, THEY ARE SHIFTING, COST SHIFTING IS THE NAME OF THE
GAME FOR HOSPITALS BECAUSE THEY GET PAID ONE RATE BY MEDICARE,
ONE RATE BY MEDICAID AND THEN WHO KNOWS WHAT THE PRIVATE
COMPANIES ARE PAYING THEM BECAUSE THEIR CONTRACTS ARE NOT
TRANSPARENT. THE ONE THING THEY CAN DO IS
GOUGE THEIR PATIENTS, PARTICULARLY THOSE THAT ARE
LEAST ABLE TO PAY. THOSE WITHOUT INSURANCE. AND THAT IS WHAT HAS BEEN
HAPPENING. EVEN THOUGH THIS IS ILLEGAL,
ACCORDING TO THE AFFORDABLE CARE ACT, AND THERE IS NO ENFORCEMENT
THERE. AND, SO, THE HOSPITAL IS DOING
WHAT IT CAN GET AWAY WITH, IT SEEMS TO ME.
AND THEN WHEN THEY ARE CALLED ON IT, THEY BACK DOWN A LITTLE BIT. THEY BACK DOWN AND SAY, OKAY,
WELL, FOR PEOPLE WHO MAKE LESS THAN 19,000 A YEAR, WE WON’T
COME AFTER THEM WITH BILL COLLECTORS AND GARNISHMENTS AND
SO ON. ISN’T THAT NICE OF THEM. IF IT HADN’T BEEN FOR THE PRESS
AND IT HADN’T BEEN FOR ADVOCATES DEMANDING MORE TRANSPARENCY,
THEY WOULD BE DOING IT AGAIN AND AGAIN AND THEY PROBABLY WILL TRY
TO DO IT AGAIN AND AGAIN.>>I WANT TO READ THIS QUOTE
HERE. DEDE TOUCHED ON THIS A LITTLE
BIT AND THE BIGGER PROBLEM WE HAVE. HERE IS A QUOTE FROM MELISSA
SUGGS, SPOKESMAN FOR CARLSBAD MEDICAL CENTER. THE MAJORITY OF ACCOUNTS FROM
WHICH WE SEEK TO COLLECT PAYMENT ARE PATIENTS WITH INSURANCE WHO
HAVE NOT FULFILLED THEIR DEDUCTIBLE, CO-PAYMENT OR
CO-INSURANCE RESPONSIBILITY SET BY HEALTH INSURANCE PLAN. THIS DEDUCTIBLE THING, IT IS
KILLING PEOPLE. DO YOU KNOW WHAT I MEAN? IT IS ABSOLUTELY KILLING PEOPLE. YOU GOT A 5, $6,000 DEDUCTIBLE
OUT OF POCKET, THAT IS NOT GOING TO WORK FOR A LOT OF NEW
MEXICANS. YOU SEE THE PROBLEM HERE? WE HAVE THE HOSPITAL IS ON THE
ONE SIDE AND PATIENT ON THE OTHER AND THERE’S A BIG MESS IN
THE MIDDLE. NOT WORKING THE WAY IT IS.>>INSURANCE COMPANIES ARE
TRYING TO MANAGE THEIR OWN LIABILITY AND THEY ARE THERE TO
MAKE A PROFIT. SO, WHAT THEY ARE LOOKING AT,
THEY ARE TRYING TO MAKE HEALTHCARE AFFORDABLE SO YOU CAN
WALK INTO THE DOOR BUT — AND MOST PEOPLE AREN’T THINKING
ABOUT THAT EMERGENCY, NOT THINKING ABOUT THAT SITUATION
WHERE THEY NEED HEALTHCARE. THEY ARE LOOKING AT THE BOTTOM
LINE. WHAT IS MY MONTHLY PAYMENT AND
THE LOWER THEY MAKE THAT MONTHLY PREMIUM THE MORE ATTRACTIVE THE
POLICY CAN BE. IT’S NOT UNTIL THERE IS AN
EMERGENCY OR EMERGENCY SURGERY OR SOMETHING OF THIS SORT, THEY
REALIZE, OOPS, THEY SIGNED UP FOR A 10,000 DEDUCTIBLE OR
20,000 DEDUCTIBLE AND THEN WHAT INSURANCE COMPANIES ARE DOING AS
WELL IS WHEN YOU’RE SIGNING UP FOR THAT INSURANCE, YOU’RE NOT
THINKING ABOUT THIS. SO THEY ARE PUTTING CAPS ON
COVERAGE SO YOU THINK I HAVE INSURANCE. I AM COVERED. AND SUDDENLY BEFORE YOU KNOW IT,
YOU HAVE EXCEEDED THAT CAP AND YOU HAVE A HUGE DEDUCTIBLE AND
MOST AVERAGE PEOPLE DON’T PLAN FOR THAT. AND IT DOES PUT THE PATIENT IN A
TOUGH SITUATION. SOMETIMES IT ADDS SORT OF INSULT
TO THAT LITTLE INJURY. YOU GO TO THE HOSPITAL WITH AN
INJURY AND SUDDENLY YOU HAVE THE BILL AND NOW —
>>INSULT TO INJURY.>>THE INSULT IS THE SALT IN THE
WOUND.>>IT BECOMES A SHOCK. I THINK IT IS A SYSTEM PROBLEM. NATIONAL PROBLEM AND NOW IT IS,
YOU KNOW, SO TO SPEAK, INTO NEW MEXICO AND WE ARE SEEING MORE
AND MORE LAWSUITS. YOU WANT TO KNOW WHAT IS BEHIND
THE CHANGE OF BUSINESS MODEL. THERE WAS A TIME THAT HOSPITALS
WOULD WORK WITH THE PATIENTS TO FIND OUT WHETHER IT IS MEDIATION
OR SOME OTHER LEVELS. NOW IT SOUNDS TO ME LIKE IN SOME
CASES THEY ARE CHOOSING STRAIGHT TO LITIGATION.>>JULIE ANN, IT WAS MENTIONED
BY DEDE THAT THE FOLKS HAVE MADE A CHANGE THERE AT THE HOSPITAL. THEY ARE NO LONGER GOING TO SUE
PATIENTS WHOSE INCOMES ARE BELOW 100% OF THE FEDERAL POVERTY
LEVEL OR ROUGHLY 19 GRAND A YEAR FOR A SINGLE PERSON. WHY ISN’T THAT THE WAY WE DO IT
HERE ACROSS THE BOARD?>>I FIND THERE IS A COMMON
THREAD IN THIS STORY WE ARE TALKING ABOUT FROM THE NEW YORK
TIMES. THE NATIONAL PUBLIC RADIO DID A
STORY ABOUT THIS, A TOTALLY DIFFERENT HOSPITAL, AND THEIR
STORY WAS ABOUT A HOSPITAL IN VIRGINIA. IN BOTH CASES, THE HOSPITALS
REFUSED TO REALLY EXPLAIN THEMSELVES AND THEN THEY CAME
OUT WITH THIS, OH, WE ARE GOING TO CHANGE OUR WAYS. AND I WAS WONDERING AND GLAD
THAT DEDE BROUGHT THIS UP, ARE THEY DOING THIS, ARE THEY MAKING
THIS DECISION BECAUSE THEY ARE EMBARRASSED? ARE THEY DOING IT BECAUSE THEY
JUST DIDN’T REALIZE WHAT THE EFFECT OF THEIR PRACTICES WERE? IT SEEMS DISINGENUOUS AND THE
FACT THERE IS A LACK OF RECORD KEEPING AND NATIONAL DATA ABOUT
THIS PUTS A STATE LIKE NEW MEXICO AND A RURAL COMMUNITY
LIKE CARLSBAD IN A PARTICULARLY VULNERABLE SITUATION. I AM CURIOUS ABOUT ALL THE REST
OF THE NEW MEXICO HOSPITALS, YOU KNOW, I WONDER IF THERE IS A WAY
FOR THE LEGISLATURE TO STUDY THIS. I AM SURE THERE ARE JOURNALISTS
ALL OVER NEW MEXICO WHO ARE NOW LOOKING, YOU KNOW, AT MORE OF
THIS IN DETAIL BECAUSE WE DON’T HAVE THE RESOURCES OF THE NEW
YORK TIMES TO DO THAT KIND OF RESEARCH, BUT I KNOW PEOPLE IN
SANTA FE WANT TO KNOW WHAT IS HAPPENING WITH PRESBYTERIAN AND
CHRISTUS AND THERE ARE COMMUNITIES LIKE TAOS,
COMMUNITIES LIKE ESPANOLA THAT HAVE ONE MEDICAL FACILITY AND
SO, NO, IT IS NOT THE WAY IT SHOULD BE, I THINK, WAS YOUR
ORIGINAL QUESTION>>YOU NAILED IT.>>DIANE, INTERESTING, JULIA
MENTIONED LOCAL STUFF, DEPARTMENT OF HEALTH HERE
ACTUALLY HAS A WEBSITE THAT LIST MEDICAID PRICE FOR NINE COMMON
PROCEDURES, BUT, MORE INTERESTINGLY, THIS FUNDING
STARTS TRACKING WHAT PEOPLE WITH INDIVIDUAL OR EMPLOYER
RESPONSIVE INSURANCE PAY. START TRACKING THAT. JULIE ANN BRUSHED BY THAT. IS THAT A GOOD START FOR YOU? SHOULD IT BE SOMETHING MORE
ROBUST GIVEN THE PROBLEMS THIS ARTICLE HAS UNEARTHED?>>I THINK ANY STEP FORWARD IS A
GOOD THING. WHAT I AM CONCERNED ABOUT IS
THAT WE — YOU HAVE TO HAVE ALL THE PIECES. YOU CAN’T JUST HAVE THIS ONE WE
ARE TALKING ABOUT. WE HAVE TO KNOW WHAT INSURANCE
COMPANIES ARE HAVING AS DEDUCTIBLES. WHAT IS EACH HOSPITAL — THE
PROBLEM GOES BACK TO RURAL NEW MEXICO IS YOU HAVE ONLY GOT ONE
HOSPITAL IN TOWN. AND IF YOU NEED TO GO TO AN
EMERGENCY ROOM, YOU DON’T HAVE A CHOICE. AND THEN YOU END UP WITH A BILL
OF 1500 AND YOU’RE DEDUCTIBLE IS 3,000 SO YOUR BETWEEN A ROCK AND
HARD PLACE. YOU CAN’T PAY EITHER ONE OF
THEM. SO IT LEAVES OUR PEOPLE IN A
VERY SERIOUS POSITION.>>LET ME READ SOMETHING TO YOU
AND GET YOUR REACTION AND OTHERS ABOUT POSSIBLY A LEGISLATIVE
FIX. FROM THE ARTICLE ABOUT THE
CARLSBAD MEDICAL CENTER, IN MAY A NATIONWIDE SURVEY BY THE RAND
CORPORATION FOUND THAT PRIVATE INSURERS PAID CARLSBAD MEDICAL
CENTER FIVE TIMES MORE THAN MEDICAID WOULD HAVE PAID FOR THE
SAME SERVICES. FIVE TIMES. SEE THIS IS WHERE I THINK THE
LEGISLATURE COULD STEP IN.>>IT SOUNDS TO ME LIKE THE
HOSPITAL IS OVERCHARGING TO START WITH. BIG TIME.>>BECAUSE THEY ARE TRYING TO
MAKE UP FOR THE LOSSES THEY HAVE IN MEDICAID AND MEDICARE SO —
>>WHEN AN INSURANCE COMPANY NEGOTIATES A CONTRACT WITH A
HOSPITAL, THEN THEY ARE HAVING TO UNDERSTAND THAT IS WHAT THEY
ARE DOING IS THEY ARE HAVING TO PICK UP THE COST.>>IMPOSSIBLE AS A CONSUMER OF
MEDICAL SERVICES, WHETHER YOU HAVE A KIDNEY STONE PROCEDURE OR
YOU’RE HAVING SOMETHING VERY SERIOUS AND ON A VERY EMERGENCY
LEVEL, YOU CAN’T FIND OUT HOW MUCH IS THIS GOING TO COST ME? WHEN YOU ASK THEM, I HAVE
PERSONALLY TRIED TO DO THIS, AND THE BILLS COME IT IS A DIFFERENT
AMOUNT THAN WHAT THEY TOLD YOU, 6, 8, 10 MONTHS A YEAR, BY THAT
TIME THEY ARE IN COLLECTIONS, IT IS SUCH A NIGHTMARE FOR THE
CONSUMER.>>THAT IS ALWAYS GOING TO
HAPPEN BUT THERE ARE STATES THAT HAVE ADDRESSED THIS. IN PENNSYLVANIA, IN MARYLAND,
THEY HAVE A ROBUST SYSTEM OF HOSPITAL REPORT CARDS AND THE
HOSPITAL REPORT CARDS ARE BASED ON SOMETHING CALLED AN ALL PAYER
CLAIMS DATA BASE. WHICH IS WHAT WE’RE MOVING
TOWARDS, FINALLY. I TWICE TRIED TO SPONSOR THIS IN
THE LEGISLATURE. IT HAS TAKEN US 10 YEARS TO GET
THIS FAR BUT YOU HAVE TO HAVE FOR THE CONSUMER A REPORT CARD
THAT SHOWS NOT JUST THAT A KNEE REPLACEMENT IN ONE HOSPITAL COST
30,000 AND 3,000 IN ANOTHER, BUT YOU ALSO NEED THE QUALITY
MEASURES. HOW SUCCESSFUL ARE THEY IN
VARIOUS HOSPITALS? WHAT IS THE HOSPITAL READMISSION
RATE FOR SOME OF THESE PROCEDURES? SO, THE CONSUMERS CAN — IDEALLY
IN NEW MEXICO IT SHOULD BE POSTED ON THE SUNSHINE PORTAL. IT SHOULD BE A GOVERNMENT
FUNCTION WHERE THE INFORMATION IS GIVEN TO THE HEALTH
DEPARTMENT. IT HAS JUST BEEN REALLY MURDER
TO GET THAT INFORMATION>>DEDE, THE COMPLAINTS THAT I
HEAR ARE, ONCE YOU GET THE BILL THE BURDEN FALLS ON THE CUSTOMER
TO CORRECT AND THAT IS AN UPHILL BATTLE.>>IT IS LIKE PEOPLE GOING TO
MEXICO FOR MEDICAL SERVICE, THIS IS WHY.>>WE HAVE TO LEAVE THAT THERE,
BUT SPEAKING OF HOSPITALS, EMERGENCY ROOMS HAVE SEEN A
SPIKE IN LUNG ILLNESSES THAT MEDICAL EXPERTS THINK ARE
RELATED TO VAPING. WE DIG IN NEXT.

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