Hospital costs have gone off the radar screen. Major efforts have gone into reducing these costs. This has included doing more outpatient surgery and sending the patients home early for post hospital home care. The home care companies, many of which have been bought out by the hospitals, may not have reduced costs.

ABC’s 20/20 reported on a child sent home on IV treatment. Critical Care America who was charging the child’s insurance company over $3,000 a day did this. That’s right $3,000, which is more than most hospitals charge for a day and adds up to about $100,000 a month. The family only became aware of it when CCA told them that their insurance was running out and the family asked for their statement of charges.

When patients are discharged, the hospitals frequently ask the physician for an order for home care. They then come up with a treatment plan which may include a RN visit once or twice a week, a physical therapy visit twice a week, a dietician visit, and others as the case may be. One of these visitors told me that they received about $112 per visit.

This was surprising to me since the same insurance carrier only paid me about half that for a visit I make every month to manage a patient on life support at which time I change his trach tube. In this era of cost constraints why are technical support visits paid at twice a doctor’s visit?

When we make a purchase on a credit card, for instance, we have to sign the statement. When we have our car fixed on an insurance claim, we have to sign off on it to make sure the service was provided. If patients had to sign off on a charge ticket every service provided, they would immediately know what was happening.

In the case of the child reported by 20/20, mentioned above, if the Home Care Company required that the family sign off on a $3,000 daily home care bill, the family would have been quite concerned in a matter of days, rather than in a few months. If a hundred million Americans had to sign off on their health care charge every time a service was rendered, it is conceivable that we would have a hundred million citizens going after health care administrators. They would find a way to get their costs down overnight. The major health cost problems would then be solved.