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Internal Medicine Just Threw Us Under the Bus

June 12, 2017

Internal Medicine takes a shot at EM
Clay Smith
This scathing article looked at hospital charges in excess of what Medicare pays for EM vs inpatient IM and concluded that, “Excess charges, or ‘markups,’ on specific services were greater when performed by an emergency medicine physician compared with an internal medicine physician.”  And that, “Further legislation is needed to protect uninsured and out-of-network patients from excess charges in the emergency department.”  The key finding of this article was that EM marked up charges more than IM.

If you are like me, you have nothing to do with what the hospital bills or the markup.  In fact, this same month, a study was published which showed most Emergency Physicians were not aware of what was being charged for their services.  When asked to estimate the cost of 3 common ED problems, less than 40% of providers identified the cost correctly.  Not that I’m praising ignorance, but it proves the point that most of us are just doing our job seeing patients, not scheming a sinister plot to overcharge them.

Spoon Feed
Get ready to face the societal and legislative backlash from this bash of ED billing practices.  Internal Medicine just threw us under the bus.  Mud slinging like this article won’t solve the problem.  Don’t miss the outstanding ACEP rebuttal to this article.

Variation in Emergency Department vs Internal Medicine Excess Charges in the United States.  JAMA Intern Med. 2017 May 30. doi: 10.1001/jamainternmed.2017.1598. [Epub ahead of print]

Peer Reviewer Comments
Thomas Davis
The biggest problem with the article is that it measures the wrong thing: the chargemaster price. Hardly anyone ever pays the full price tag, even the uninsured. Instead, an analysis from New Hampshire’s Comprehensive Healthcare Information System would be more enlightening. This all-payer claims database uses actual dollars paid to produce NH HealthCost–a website that publishes cost estimates tailored to one’s insurance status or plan. This is a big step in the right direction towards price transparency.  Link: nhhealthcost.nh.gov

What are your thoughts?