Reimbursement Disparity: Bad for the Patient

I feel the hospitals are at a disadvantage with reimbursement for services in the OR. As I have worked in this field and learned the billing aspects of IOM, it has become apparent to me that reimbursement for separate groups is very good, where most hospitals are reimbursed at a very low rate - if they are paid at all. Most are entered into contracts with private insurance companies and are paid lump sums for the patients stay, similar to a DRG, and of course all of the DRG's themselves.

In dealing with several hospitals over a fairly wide area I have not found one yet that has been able to just break even for any of these services. I think this is a big reason why tech salaries have not come up the way they should, and IOM has come along but certainly not with the force that it should.

In the beginning I was assuming that the billing personnel were not coding or billing correctly, however, I have since learned that they are doing it correctly, but they are just left in a void. Please note that these are hospitals with medical direction just no individual group billing the professional componant separately. I also am aware that insurance reimbursement varies dramatically across the country and some areas reimburse better than others. I just feel that if a hospital wants to have a program to make there institution a better and safer place to have this specialized surgery, then they should be able to afford to do it without taking such a hit every time.

This also opens up the whole debate about surgeon driven devices which we all know are dangerous and extremely lacking, however, the hospitals are much of the time reimbursed better for the 'disposable, one time use, patient harness' than they are for full services. The 'patient harness' is nothing more than a few disposable subdermals or sticky patches taped together and tagged with an exuberant price tag. I have actually been told that even though it is lacking and there is no service that comes with it, the hospitals are still using it because they get paid for it...I know this topic is hot and there is a lot to come of it and I hope it comes in time to help the masses of innocent patients.

~IOM-juNkiE