美国国家公共电台 NPR Bill Of The Month: A Tale Of 2 CT Scanners — One Richer, One Poorer

 

STEVE INSKEEP, HOST:

Today, we have a tale of two medical bills - same patient, same test, but one test cost 33 times more than the other. It's our bill of the month, part of a series with Kaiser Health News in which we examine real-world medical bills and try to make sense of them if they make any sense. NPR health policy correspondent Alison Kodjak talked with our co-host Noel King about a particular bill shown us by a listener in Florida.

NOEL KING, BYLINE¹: Hey, Alison.

ALISON KODJAK, BYLINE: Hey, Noel.

KING: All right, so tell us about this patient and these two very different charges.

KODJAK: Yeah. So this is a young man in Florida named Ben Hynden, and he sent us this pair of bills that were really remarkable² because they show how the cost of the exact same test - a CAT scan - can be just wildly different depending on where you get it.

KING: And the only difference was location.

KODJAK: Yeah. He got two CAT scans about three months apart, and the first cost less than $300. He had that one done at an imaging center, a place that only does things like X-rays, CAT scans, MRIs. The second one, on the other hand, cost $9,000 - just about 9,000.

KING: From 300 to nine - I mean, I would laugh, but that's not funny at all. What was the different - what happened here?

KODJAK: Yeah, so this one, he had done in an emergency room, which health economists³ will tell you is the most expensive place to get care. But even in that context, this price difference was pretty extreme. So I went down to Fort Myers. I met Hynden, and we went around to see what we could learn.

BENJAMIN HYNDEN: Let's go see the hospital.

KODJAK: We met up at his office, and he took me on a little tour. Our first stop was the emergency room at Gulf⁴ Coast Medical Center, where he got that really expensive CAT scan.

UNIDENTIFIED PERSON #1: We're just going to take her for some bloodwork. We'll be right back.

UNIDENTIFIED PERSON #2: All right.

KODJAK: This hospital and pretty much all the hospitals in Fort Myers are owned by a company called Lee Health. Hynden says he ended up here after calling his doctor's office, worried about this nagging⁵ pain in his stomach.

HYNDEN: I was just feeling, like, really bothered. And I was like, I kind of hope nothing's wrong. Let me just call my doctor to see, you know, what he thinks.

KODJAK: But his doctor was away, and a nurse practitioner⁶ worried that Hynden could have appendicitis⁷. But once he's at the ER, a triage nurse rules that out.

HYNDEN: She goes, you're definitely not having appendicitis; you would've had a much higher fever, much more severe symptoms.

KODJAK: But the nurse recommended he get some tests anyway, and one was this almost $9,000 CAT scan. Of course, at the time, Hynden had no idea it was going to cost that much.

HYNDEN: I mean, for me, I was - I was just shocked.

KODJAK: It turns out his insurance company had negotiated a lower price - about $5,500. And some of that was covered, but in the end, Hynden, who has a high-deductible insurance plan, is on the hook for more than $3,500.

HYNDEN: Lee Health is probably not going to be very happy that I, you know, told anyone about what they charge me.

KODJAK: Yeah.

HYNDEN: But I'm not happy with them.

KODJAK: He's not happy because just a couple of months earlier, he had the same test right up the street. So we get back in the car, and he takes me there. Fort Myers is a sprawling⁸ suburban⁹ city. We passed an Applebee's and a Costco.

HYNDEN: And then, you know, SuperTarget, and Starbucks and Moe's.

KODJAK: One thing I notice is there are buildings with the blue and green Lee Health logo on them - a lot of them. In fact, Hynden's doctor works for a practice owned by Lee Health. And then we pass by an urgent care center.

HYNDEN: Hey, look. It's part of Lee Health, too. What the heck? Man, you can't go anywhere without seeing Lee Health.

KODJAK: Less than 10 minutes from the hospital, we pull into a little office park and stop at Summerlin Imaging Center. This one's not owned by Lee Health, and it's where Hynden got his first CAT scan. I go in, and the owner, Rick Davis, shows me around.

RICK DAVIS: So anyway, this is the imaging center, and this is the control room for both CT and MRI.

UNIDENTIFIED PERSON #3: Hi, how are you?

KODJAK: Two women look through glass as a patient lies in an MRI machine.

(SOUNDBITE OF MRI SCAN)

KODJAK: Across the way, a big, round CAT scan machine is visible through another window. Davis says his prices, like the $268 he charged Hynden for his scan, are dictated¹⁰ by insurance companies and Medicare. Small, independent companies like his don't have power in this market. Davis points to a pile of patient statements, and they show the reimbursements¹¹ from insurance companies fell - sometimes by half - in the last few years.

DAVIS: If you do not agree to take the decreases, they'll cancel your contract. So when they finally put us out of business, they can have nothing but the hospital to go to.

KODJAK: And hospital care is always more expensive than outpatient care.

KING: OK, so that's why a test would cost 33 times more at a hospital.

KODJAK: Well, that's part of the reason. So I talked to Bunny Ellerin, and she runs this Healthcare and Pharmaceutical¹² Management Program at Columbia Business School. And here's what she says about it.

BUNNY ELLERIN: When you think about the emergency department, it's really the front door to care. They are providing 24-hour unfettered access and by law - by federal law - must treat everyone who comes in - right? - whether they have insurance or the ability to pay.

KODJAK: And then there's this virtual monopoly in Fort Myers. Lee Health owns all the hospitals and also employs many of the doctors in town, so, that gives them this power to charge pretty much whatever they want.

KING: Did you get to talk to Lee Health about this? What'd they say?

KODJAK: Well, I tried to talk to Lee Health. No one would go on tape and talk to me for the story. But a spokeswoman sent me a long statement, and she essentially¹³ echoed what Bunny Ellerin said. She says it's expensive to run an ER, so any tests performed there are going to cost more.

KING: Is the city of Fort Myers unusual in some way?

KODJAK: Well, it's a specific case, but it's not that unusual. There are other cities with dominant¹⁴ hospital systems. And I talked to Gerard Anderson. He's a professor of health policy and management at Johns Hopkins. And he says his research shows that cities with big hospital systems and not much competition in general have much higher prices. So on Hynden's bill, the price was $8,897 for this CAT scan, and it comes from what's called a master price list. And Anderson says hospitals mark up all the prices on the list by a lot.

KING: Yeah, but then do people actually pay those prices?

KODJAK: Not many people do. Anderson calls them fairy-tale prices. So the higher they are, though, the worse it is for consumers because insurers negotiate down from the very high first number. And so Ben Hynden, he's still on the hook for $3,500 for this test that only cost $300 just down the road.

KING: Man. NPR's Alison Kodjak, thank you.

KODJAK: Thanks, Noel.

KING: You can also share your stories with us. NPR and Kaiser Health News want to see some of your medical bills, whether they're sky-high or just interesting - bills where there's a story to tell that we can then investigate. If you want to participate, go to NPR's Shots blog. You can tell us about your experiences, and you can upload your bills. There's a form.

(SOUNDBITE OF AARON PARKS' "RIDDLE ME THIS")

1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 remarkable   

adj.显著的，异常的，非凡的，值得注意的

参考例句：

• She has made remarkable headway in her writing skills.她在写作技巧方面有了长足进步。
• These cars are remarkable for the quietness of their engines.这些汽车因发动机没有噪音而不同凡响。

3 economists   

n.经济学家，经济专家( economist的名词复数 )

参考例句：

• The sudden rise in share prices has confounded economists. 股价的突然上涨使经济学家大惑不解。
• Foreign bankers and economists cautiously welcomed the minister's initiative. 外国银行家和经济学家对部长的倡议反应谨慎。 来自《简明英汉词典》

4 gulf   

n.海湾；深渊，鸿沟；分歧，隔阂

参考例句：

• The gulf between the two leaders cannot be bridged.两位领导人之间的鸿沟难以跨越。
• There is a gulf between the two cities.这两座城市间有个海湾。

5 nagging   

adj.唠叨的，挑剔的；使人不得安宁的v.不断地挑剔或批评（某人）( nag的现在分词 )；不断地烦扰或伤害（某人）；无休止地抱怨；不断指责

参考例句：

• Stop nagging—I'll do it as soon as I can. 别唠叨了—我会尽快做的。
• I've got a nagging pain in my lower back. 我后背下方老是疼。 来自《简明英汉词典》

6 practitioner   

n.实践者，从事者；(医生或律师等)开业者

参考例句：

• He is an unqualified practitioner of law.他是个无资格的律师。
• She was a medical practitioner before she entered politics.从政前她是个开业医生。

7 appendicitis   

n.阑尾炎，盲肠炎

参考例句：

• He came down with appendicitis.他得了阑尾炎。
• Acute appendicitis usually develops without relation to the ingestion of food.急性阑尾炎的发生通常与饮食无关。

8 sprawling   

adj.蔓生的，不规则地伸展的v.伸开四肢坐[躺]( sprawl的现在分词 )；蔓延；杂乱无序地拓展；四肢伸展坐着（或躺着）

参考例句：

• He was sprawling in an armchair in front of the TV. 他伸开手脚坐在电视机前的一张扶手椅上。
• a modern sprawling town 一座杂乱无序拓展的现代城镇

9 suburban   

adj.城郊的，在郊区的

参考例句：

• Suburban shopping centers were springing up all over America. 效区的商业中心在美国如雨后春笋般地兴起。
• There's a lot of good things about suburban living.郊区生活是有许多优点。

10 dictated   

v.大声讲或读( dictate的过去式和过去分词 )；口授；支配；摆布

参考例句：

• He dictated a letter to his secretary. 他向秘书口授信稿。
• No person of a strong character likes to be dictated to. 没有一个个性强的人愿受人使唤。 来自《简明英汉词典》

11 reimbursements   

n.偿还( reimbursement的名词复数 )；退款；补偿；赔偿

参考例句：

• We had to put in for the food reimbursements again. 我们不得不再次申请食物赔偿。 来自互联网
• Have you figured up the total of the reimbursements I gave you? 你有没有把我给你的报销账目全部加总了呢？ 来自互联网

12 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

13 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

14 dominant   

adj.支配的，统治的；占优势的；显性的；n.主因，要素，主要的人(或物)；显性基因

参考例句：

• The British were formerly dominant in India.英国人从前统治印度。
• She was a dominant figure in the French film industry.她在法国电影界是个举足轻重的人物。