Science
Opinion: Same hospital, same injury, same child, same day: Why did one ER visit cost thousands more?
The Kaiser Family Foundation recently reported that the annual cost of family health insurance jumped to nearly $24,000 this year, the greatest increase in a decade. While insurance executives and employers may cite a plethora of reasons, one of the chief culprits is lack of oversight over the Wild West of healthcare prices.
My friend encountered a dramatic example of this last year after her 4-year-old daughter had the misfortune of suffering the same injury twice in the same day.
The girl’s parents were getting her ready for school one morning when, as her hand was pulled through a shirt sleeve, she experienced severe pain. They took her to the children’s emergency department down the road from their home in the Bay Area, where she was diagnosed with “nursemaid’s elbow” or, more technically, a “radial head subluxation.” Common in young children, whose ligaments are looser than adults’, the partial dislocation is straightforward to diagnose and treat. A simple maneuver of the elbow put it back in place in seconds.
After coming home from school that afternoon, my friend’s daughter was playing with her babysitter when her elbow got out of place again. They went back to the same emergency department and went through the same steps with another doctor.
My friend, who is fortunate enough to have good insurance and the means to pay her share, knew the bills wouldn’t be cheap. What she wasn’t expecting was such a stark illustration of the arbitrary nature of medical billing.
While the bill for the first visit was $3,561, the second was $6,056. Same child, same hospital, same insurance, same diagnosis, same procedure, same day — and yet the price was different by not just a few dollars or even a few hundred dollars, but nearly double.
How do we make sense of this? How can a patient be charged such wildly different prices for the same treatment on the same day?
Emergency room billing consists of hospital fees and professional services fees. The hospital fees include a “facility fee” that is part of every emergency room visit and coded at one of five levels. Level 1 is the simplest — someone needing a prescription, for example — while Level 5 is the most complicated, for problems such as heart attacks and strokes that require significant hospital resources. And of course there can be additional hospital fees for X-rays, medications and the like, which weren’t necessary in the case of my friend’s daughter.
The professional services fees are for the emergency physician and other providers such as radiologists. In this case, there were no fees for professionals other than the emergency room doctor.
But the itemized charges showed the two visits were billed completely differently. The first was charged a Level 1 facility fee and a Level 3 professional fee. And the bill tacked on additional fees, including hospital and professional charges for taking care of the patient’s injured joint.
The second visit, meanwhile, was charged a Level 2 facility fee and a Level 4 professional fee, both higher than that morning. But in contrast to the earlier visit, no other charges appeared.
Why was the same injury coded as more complex and expensive to treat the second time than the first? Why did the coding and billing company decide to charge for additional services for the first visit but not the second?
I know both of the physicians who treated my daughter’s friend; they work in the same group, use the same billing and coding company, and charge the same rates. So the different doctors don’t explain the discrepancy. In my practice, even treating physicians have no access to information about how billing for our services is determined.
My friend and I contacted the hospital’s billing department repeatedly, but they proved unable to provide any rational explanation.
Unfortunately, this isn’t new. About a decade ago, I published a series of studies showing how arbitrary medical billing can be. Hospitals charged fees ranging from $10 to $10,169 for a cholesterol test; $1,529 to $182,995 for an appendicitis hospitalization without complications; and $3,296 to $37,227 for a normal vaginal birth.
Only uninsured patients are asked to pay these sticker prices. But despite the “discounts” granted to insured patients through their insurance companies, these charges end up sneaking into higher premiums and other costs. Medical bills are responsible for about 59% of U.S. bankruptcies.
There are few certainties in life, but one of them is that we will all need healthcare at some point. And another, at least for those of us living in America, is that we have no idea what it will cost or why. This would never be tolerated in any other industry.
What can we do about it? Here’s where we could benefit from a government agency like the Consumer Financial Protection Bureau, which helps regulate banks and other financial entities that perpetrate what have been called “injustices against everyday Americans.” We need someone to regulate the injustices inflicted on Americans every day at the hands of the healthcare system too. Recent efforts by the Federal Trade Commission and the Department of Justice to police healthcare mergers and address other anticompetitive behavior in the industry could also help.
More government regulation and oversight won’t address the more fundamental problem that we keep trying to treat healthcare as a market good, which it clearly isn’t. But it could help ensure that treating a minor injury one afternoon doesn’t cost twice as much as it did that morning.
Renee Y. Hsia is a professor of emergency medicine and health policy at UC San Francisco as well as a Soros fellow and a Public Voices fellow at the OpEd Project.
Science
Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County
A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.
The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.
The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.
Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.
The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.
After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.
As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.
Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.
The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.
Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.
Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.
The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.
Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.
While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.
Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.
Science
Political stress: Can you stay engaged without sacrificing your mental health?
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
Science
Video: SpaceX Unable to Recover Booster Stage During Sixth Test Flight
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