Who Are Responsible For Outrageous Medical Bills? Hint: It’s Not Doctors.

Over the last few years, there has been a slew of articles about patients receiving surprise bills after ER visits. One woman was charged $5,751 for an ice pack and a bandage. An infant was charged $937 for an antibiotic ointment. Who sends bills like that? Is it the ER doctors? No. It’s large corporations.

ER docs want to help you regardless of your insurance.

In fact, as an ER doc, I usually have no idea if my patients are even insured when they roll in. The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires us to treat everyone who walks in the door regardless of their ability to pay. We proudly consider ourselves the safety net of the community. The Department of Health and Human Services estimates that ER docs spend about 55 percent of their time providing uncompensated care. This is the most of any medical specialty. We take our physician oath seriously.

But many of us work for large corporations.

The majority of ER docs work for one of three types of employers: 1) small private physician groups; 2) hospital systems; or, 3) contract management groups or CMGs. CMGs are essentially hospital staffing companies that function as large corporations. They employ ER docs and put them to work in hospitals with which they hold staffing contracts. By promising to streamline administrative tasks (such as physician credentialing, insurance billing, and corporate taxes), CMGs have taken over many smaller physician groups and hospital systems. They now hold staffing contracts with hundreds of hospitals around the country.

And these corporations want to generate profits.

Some estimate that half of the nation’s emergency departments are currently staffed by CMGs. Their priority is not to provide quality patient care. It is to generate profit. Some CMGs were traded on the New York Stock Exchange. Others have who cannot pay. A study done by economists at Yale delved further into how CMGs use their power to exploit patients for profit.

CMGs now staff half of the nation’s emergency departments. Their priority is not to provide quality patient care. It is to generate profit.
A CMG can refuse to participate in insurance networks, which work on behalf of patients to negotiate discounted rates for medical care. These are called in-network rates. It will instead charge patients exorbitant out-of-network rates. Compared to the prior physician group that staffed a hospital, it can raise charges by a whopping 96 percent. These predatory billing tactics are directly responsible for the exorbitant ER bills being sent to patients.

These corporations may also be illegal.

Believe it or not, it gets worse. These corporations are likely violating both federal laws that prohibit physician fee-splitting and state laws that prohibit the corporate practice of medicine. Unfortunately, there is no public agency in place to enforce these laws. There was a case in Texas where the court concluded that the existence of a CMG was in violation of the state’s Medical Practice Act, but that case is from over 30 years ago.

We are struggling to fight for our patients.

Physicians are distraught over this situation, but over 60 percent of us are afraid to speak up out of fear that we will be terminated without cause. Some of us want to help fix the billing process, but CMGs insist on engaging in “closed-book” billing. That means they will not allow physicians to review what a patient is being billed. Consequently, physicians are turning to advocacy organizations for help in this fight.

And the integrity of our advocacy organizations is questionable.

The president one such organization is also the vice president of one of the largest CMGs in the nation. It seems that corporate interests have infiltrated even our own advocacy organizations.

Congress is finally taking notice.

Given all of this, it is not surprising that CMGs have gained the attention of Congress. Recently, Congress announced it would look into their role in surprise billing. Shortly after this announcement, a CMG’s CEO resigned. Maybe there is hope after all.

Ashima Vohra is an emergency medicine resident.

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