Guest Column: New Proposal in Congress Around Surprise Billing Could Drive Doctors Out of South Dakota

New Proposal in Congress Around Surprise Billing Could Drive Doctors Out of South Dakota

Dr. Cohen is a board certified interventional pain management specialist and is Medical Director of American Pain Relief Institute in Yankton, SD.

We don’t usually think of health care as a market. When our child is sick, we aren’t contemplating supply and demand—we just want them to get better. But capitalist forces still apply to health care. This means bad policies like price controls can cause health care shortages here in America as easily as they do food shortages in Venezuela.

Unfortunately, some of our federal elected leaders are acting like health care is immune to such impacts. They want to set government-mandated rates for much of the care doctors and other medical professionals deliver.

It’s a crazy idea born from good intentions. These lawmakers are focused on cutting down on surprise medical bills some patients get after receiving care they didn’t realize was outside their health plan network. This is a real problem in metropolitan areas. In New Jersey, for instance, nearly one in three medical emergencies results in an unexpected bill, according to a Kaiser Family Foundation analysis. We do better here in South Dakota—our number is just 4 percent.

We don’t have a bad case of the surprise billing “disease” but the “cure” proposed by Congress would do the greatest damage in rural parts of the country like ours. The vast majority of South Dakota counties already face severe doctor shortages. We aren’t adding nurses in adequate numbers to replace those retiring. And although South Dakota invests more in salaries than most other states, we’re struggling to build a sufficient health care workforce.

“If government price fixing adds to these challenges, we will be in dire straits indeed.”

Sadly, the most vulnerable among us will bear the greatest burden. Rural areas have aging populations with extensive health care needs. Moreover, one in four U.S. military veterans lives in a rural community. With only three VA centers and a handful of clinics across our state, many former service members rely on local doctors for everything from checkups to PTSD treatment.

The veterans I work with often deal with daily pain because of injuries they sustained while serving our country. Similarly, my senior patients worked hard and raised families but now suffer various aches, degenerative disease, and other painful problems. These deserving people—and all patients—need access to quality care, including safe, effective pain management. But fewer doctors will be here to offer it if price controls are in place.

Have no doubt, the system-wide consequences of the surprise billing legislation would be life-threatening. With more doctor shortages, a person suffering depression may be unable to get psychiatric help before taking his own life. A woman with a breast lump might not get treated before her disease spreads.

Even one unnecessary tragedy would be an unacceptable outcome of this blanket pricing policy conceived in Washington to address a problem South Dakota has largely fixed. Price controls don’t work for our state, and our leaders in Congress should say “no.”

Dr. William Cohen

17 Replies to “Guest Column: New Proposal in Congress Around Surprise Billing Could Drive Doctors Out of South Dakota”

  1. Anonymous

    I have read this twice and it doesn’t make any sense to me.
    1 – Who is proposing this legislation and what would it actually do? There must be more to it than just “price fixing” because that in no way solves the stupid problem of unexpected bills.
    2 – What is it about this legislation that would lead doctors to leave rural areas? This column doesn’t explain that.

    The basic argument being presented here is: “I don’t like this, and so I am going to give it a pejorative name, and threaten a bad result if it happens.”

    I don’t have a dog in this fight. I may even agree with this guy, but I can’t tell from this column what is going on here.

    1. Anonymous

      You’re not wrong, it doesn’t make any sense. Or rather, there’s no point other than “bad.”

  2. Anonymous

    South Dakota is the most lucrative state to practice medicine. Socialized agriculture, socialized dairies, socialized cheese, socialized livestock production, a socialized timber industry, socialized air service, socialized freight rail, a socialized nursing home industry and now a socialized internet are all fine with Republicans in South Dakota but then they insist single-payer medical insurance is socialized medicine.

    1. duggersd

      No they’re not. They are non-profit. They just have to keep building huge buildings to stay non-profit.

  3. Realist

    The price transparency bills working their way through Congress dont encompass the whole picture. While I agree that patients should, by common sense, have access to such information. What these statutes say is that the hospital would need to post the prices on the 300 most used services in their system – 70 of which are pre-determined by the Government. That is just the list or invoice price, which doesnt encompass each individual’s insurance status, whether or not they’ve met their deductible, availability of financial assistance, in v. out of network, etc. Recall that a similar bill passed, I believe mandated by Obamacare, for hospitals and insurance companies to post prices online for certain services. Has anyone used or shopped around based on those posted prices?

  4. Anne Beal

    We do have a problem in SD.
    Over ten years ago I was advised to have a DEXA scan to check for bone density. But nobody, and I mean nobody, not the doctor, the billing office, the radiology department, nobody would tell me what it would cost. Nobody would even tell me if it would be three figures or four. Not even a hint.
    So I didn’t have it done.
    Recently I did have one and I’ve already got osteoporosis. Could have used that information 10 years ago.
    A co worker of mine thought her outpatient sinus surgery was all pre-approved and in network. And then the insurance company denied the whole claim. Wouldn’t pay a cent. I told her to sue for breach of contract but she declared bankruptcy instead. She wouldn’t have had the surgery if she had been told it wouldn’t be covered, but she was assured it would be. She blamed the providers as much as the insurance company.
    Another coworker was told a biopsy, performed by the same pathology lab which was in-network for all our Pap smears, was out-of-network for everything else. And while the hospital was in-network, the anesthesiology was out-of-network.
    There is nothing wrong with advertising prices, and telling the patients upfront what an elective procedure is going to cost them.

    1. a friend of education

      Strongly agree with Anne Beal. We all have similar stories. We’ve been assured a procedure or test is covered by the $1700/month health insurance our federal government mandates we purchase and then…oops! oh well. Guess not. Sorry. Please re-read fine print conveniently located in subparagraph 96, on p. 65 of your annually-updated user agreement.

      That’s baloney!

      Patients need to know the risks they face: health risks and economic risks.

        1. Anne Beal

          It doesn’t matter which insurance company you use.
          25 years ago I needed rabies shots.
          That time I was able to do some comparison shopping: $1500 in Flandreau, $3000 in Brookings.
          Even if you have met your deductible and insurance will pay 80%, the difference in the out-of-pocket costs makes shopping around worth the effort.
          It’s frustrating, though, when you make those phone calls and nobody will tell you.

          1. a friend of education

            Exactly. I’m not here to bash one specific company. In my limited experience, the SD-based entities are *superior* to most others (wellpoint, humana, aetna, cigna, bcbs, etc.) That fact doesn’t excuse their faults or imply we don’t need reform. The problems are systemic & the federal regulatory scheme is….deeply flawed. That local players do a fair job mitigating perverse structural liabilities is admirable, but (ultimately) irrelevant.

  5. tara volesky

    Patients are paying more while hospital executives earn millions of dollars a year. In SD we should have a non-profit cooperative owned by the members who receive coverage with “profits” returned to patients in the form of lowered costs.

    1. Anne Beal

      The issue is, when you make a major purchase of a car or house, all the costs are listed, in black and white, before you sign the contract. And you can shop around for a better deal, too. It’s all up front.
      But an elective medical procedure? Nope. You won’t know what that Coronary Artery Bypass Graft is going to cost; they won’t tell you. Back in the 90s, word got out that an average CABG at McKennan (Avera) cost $45,000 to Sioux Valley’s (Sanford) $30,000. (Its a long story.)
      There is no reason providers cannot give you an estimate, which you can present to your insurance company ahead of time, and ask “how much of this are you going to pay?”

  6. tara volesky

    It’s something the Governors and Legislature is afraid to deal with. I simple law would take care of the problem.