As a health care finance consultant you can imagine my disgust and shock at seeing a headline and news story like this one: This $153,000 rattlesnake bite is everything wrong with American health care.

As a potential patient, I know something like this flames people’s emotions. As someone in the industry, I was also inflamed… but for a much different reason.

The cast is cut!
Molly Marshall via Compfight

First, let’s dissect the story. This poor patient got bitten by a rattlesnake and had to be rushed to the hospital. He went in through the emergency room and, based on his injury, I wouldn’t doubt that he got the highest level of care charge, a step below trauma since he didn’t have to be operated on. He did have stitching and some other things that occurred, but whether they occurred in the ER or in another room… hard to say.

The cost was over $5,500 dollars; that’s high in at least 97% of all American cities in the nation but San Diego is an expensive city. I still think it’s possibly outrageous, especially based on some of the other charges on the bill.

Second, the emergency room bill was outrageous because he left there and was taken to the intensive care room. That’s where most of his treatments would have taken place, since he was admitted to the hospital as an inpatient. Thus, he probably didn’t spend much time in ER (because they would have known what was wrong with him & moved him fairly quickly), unless they had to revive him from shock (which we don’t know), the ER charges seem inflated… but truthfully might not be. Being bitten by a rattlesnake is pretty serious stuff.

Still, seeing that the intensive care room is over $17,700, and there’s an intermediate care room coming in around $21,000, it seems like the ER charges are still way too high.

Here’s a reality most people don’t know. Each level of room charges comes with a level of care and procedures that justify charging for them. Those charges are supposed to capture expenses for whatever it is they do. Intensive care is never inexpensive because, other than surgery, it’s the most critically care area in every hospital as it pertains to patients.

So, he was an inpatient for 5 days (we don’t count the day of discharge) and, based on the cost of ICU, that’s not bad at all. I don’t have a problem with ICU. His time spent there is probably what kept him alive.

I do have a problem with the intermediate care level charges. When patients are at that level it’s basically considered a maintenance level, relatively minimal services. He probably got moved there to receive more of the anti-venom serum and was monitored but way less so than if he’d stayed in ICU.

However, it’s possible that the terminology is different than what I’m expecting. In most hospitals regular inpatient rooms are usually categorized as semi-private or private. Calling it intermediate care level might be what they call those rooms; without an itemized bill we wouldn’t know. It’s possible that he spent one day in ICU and 4 days in a regular inpatient room. For San Diego that’s probably a normal inpatient charge.

Third, the lab charges. Actually, that’s the one area where I have no problem with the cost of services. That’s because he’d have not only needed those, but lots of them, probably hourly, to see how the medication was working in getting the venom out of him.

Fourth… here’s the biggie. The pharmaceutical charges are over $83,000! The bulk of that is the anti-venom serum, and according to the story they used so much on him that they depleted the reserves of two other hospitals in the area (ask me at another time why I prefer to live in the northeast…).

Fotografía Clínica Granados
Creative Commons License Iguanageek via Compfight

Years ago I wrote a story here telling people why prescription drugs cost so much. This story is a little different because it seems that there’s only one lab that makes this stuff, and with no competition the cost of this stuff is pretty high.

This is a tough one for people to understand but rattlesnake bites, as bad as they are, aren’t as common as people might believe. So, there’s no clamoring by other pharmaceutical companies to get into the product line. When that type of thing happens the cost of making these types of drugs are higher than they are for making things like over the counter medications. Thus, the high cost of getting it.

So, when you look at the bill like this, based only on what we know, a 5 day hospital stay for something relatively uncommon that ended up involving 2 hospitals that came to $159,000 isn’t really all that bad.

If that’s true, then what’s wrong with health care?

What’s wrong with health care is that, if you read the story at the link, it seems no one could tell either the press or the patient why the bill was that high, and no one could explain why, even with the bill that high, the patient wouldn’t actually have to pay all of that out of pocket. For that matter they’re not even sure if that’s true because this guy did something dangerous and fairly dumb, and depending on what his insurance is it’s always possible that they could deny it for just that reason.

Transparency is a major topic in health care these days. There are two truths to this discussion. One, hospitals don’t do a good job in helping patients understand why their bills are like they are. Two, patients don’t really care about their bills until they get them, and then they’re mad.

When transparency first came up, some hospitals across the country put their list of charges on their websites; some hired people to handle patient calls about charges before they came to the hospital.

What happened is that the pages with the charges got almost no views and the phone calls amounted to fewer than one a week. Folks, you can’t complain about hospital bills one day and not care about hospital charges another day and call it fair.

What’s wrong with health care? For the most part the people who should know how charges work don’t, and the people the charges affect most don’t care until after the fact. That’s a broken system, but until you, the people, actually care more there won’t be much encouragement to change things.