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Brooksville Regional Hospital ER visit: apathetic care at a high price

My son's helmet, thankfully, saved him from a serious head injury when he fell off his bicycle in June.

Still, his lower teeth just about cut through to the skin, leaving a hideous gash inside his mouth. Red scrapes covered his face like war paint, and a gravel-flecked divot in his chin went almost to the bone.

Since this happened on a Saturday evening, my wife and I felt we had no choice but to drive him to the emergency room of the closest hospital, Brooksville Regional.

My aim here is to discuss the cost of his care and what it says about the need for reforming our medical system, not to judge a local hospital based on one visit.

And, because four months have passed and my then-11-year-old son was the patient, I don't fully trust my memory or objectivity.

The hour I remembered us spending in the waiting room, for example, was actually 23 minutes, the hospital told me last week.

If the physician's assistant seemed snippy, well, my wife and I, impatient for my son to be treated, were probably snippy, too.

I could comment on the emergency management technician to whom the actual care of my son — that is, washing out his wounds with saline solution — was delegated. I could say he showed all of the concern and pride of a prison trusty and, with a barbed-wired tattoo circling his biceps, kind of looked like one. But that would be judging based on appearance.

My memory might have been further clouded by the fact that before my boy received any real medical attention, a clerk walked into the room to ask us how we wanted to handle our co-payment.

Okay, I guess I've done it to some degree: criticized Brooksville Regional's care. And maybe that's okay. Because the issue here is value — what patients get for the money. What we got was competent enough that my son made a complete recovery. But the care seemed apathetic and incredibly overpriced.

I knew hospitals operated in a reality separate from the normal free market. But until now I didn't realize they were quite up there in the same otherworldly realm as defense contractors.

Brooksville Regional charged $1,036 for our hour or two in the emergency room, including $81.88 for "supplies" (an ice pack, saline and gauze) and $91.95 for "drugs" (two ibuprofen tablets and three little foil envelopes of Neosporin).

Then came the separate bill of $508 for a doctor whom we never saw.

There was, however, a doctor on hand who supervised my son's care, said Brooksville Regional chief financial officer Greg Pearson. The cost of accessing the emergency room is based on the staff and equipment the hospital must keep on hand there, Pearson said.

"We have to be prepared for a train wreck," he said.

Also, he pointed out, neither private nor government insurers typically pay the full fare. True, but since my insurance company received a discount of only about 20 percent, and still paid $73.10 for Motrin and Neosporin, this explanation didn't satisfy me.

I found a better one in How American Health Care Killed My Father, a brilliant article in the September issue of the Atlantic magazine (theatlantic.com/doc/200909/health-care/4).

Author David Goodhill wrote that the inflation of medical treatment and growing indifference to quality has come about because "you are not the customer." Doctors and hospitals don't have to satisfy us or charge us fairly because insurers have so much say in where we seek care and how much it costs.

The insurers, of course, pass this expense back to us, Goodhill writes, which is why a 22-year-old worker and his employer might expect to pay $1.77 million for health insurance over the course of his lifetime.

Emergency care is especially far removed from its true value.

To justify the regulatory privileges that allow hospitals to claim, for example, 38 times as much money from Medicare as they did in 1970, Goodhill suggests they overstate the costs of emergency care and therefore the amount of free service they provide to indigent patients.

"Consider the oft-quoted 'statistic' that emergency-room care is the most expensive form of treatment. Has anyone who believes this ever actually been to an emergency room?"

I have and, no, I don't believe it.

Brooksville Regional Hospital ER visit: apathetic care at a high price 10/11/09 [Last modified: Sunday, October 11, 2009 6:09pm]
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