Cost of medication as an inpatient is SHOCKING!!!

RN auditor · Jul 31, 2003

I would highly recommend my parents go North of the Border for their medications. I think it is ridiculous the amount of time and money that must go into the FDA certifying medications. I heard that it sometimes takes years just to get one medication approved. Beaurocracy is what is raising the cost of medication and care. No wonder people are going to other countries for meds and care.

healingtouchRN · Jul 31, 2003

I really considered it when I was south of the border last year. Meds we soooo cheap. but I questioned 1) was it really what it says it is, 2) it is quality? Fearful of being poisoned or having some limb just fall off, I just bought my usual Vanilla by the quartfuls (best in the world) & some t-shirts... :rolleyes: It just erks me that my same birthcontrol pills I bought in the 80's are triple the cost, for 21 little tabs, I don't even use the placebos, I can count, thanks. Almost 40 bucks, unreal!!! okay off the box again.

flowerchild · Jul 31, 2003

Yes, the hospitals expect the private payors to pay the full amount since it is not prenegotiated. SOL. A private payor may offer a settlement on the account and it will probably be accepted but then it will show up on the persons credit report. They don't expect private payors to ante up so they charge the high amounts for their own benefit. This way they can write it off as a loss, decreasing their tax burden. I can't beleive the way the hospitals get away with what they do. AND, I hate the way they cry poor mouth to the nurses and staff all while some few at the top are padding their pockets, but that's another subject.

kimmicoobug · Jul 31, 2003

Here is an example that I can share. At my facility, primary IV tubing costs $125. The IV start and secondary tubings are considered included in this charge. Tylenol here is 5 dollars. Not too bad considering I can buy a few bottles with that much.

mattsmom81 · Jul 31, 2003

yes, Flowerchild, this is indeed what facilities do. Another reason facilities will use and even at times PREFER contract and agency nurses over their own staff is for the same reasons...they can write the contract/agency expense off as a loss and make out better come tax time. They also save on costs of maintaining them, insuring them etc. (I found this out during my very short stint in management)

I agree with Ainz we need to talk in a language administrators understand. They seem to understand customer satisfaction. Perhaps when we can relate nurses' needs to patient satisfaction we will make some headway.

From some posters in this forum, at least SOME administrators are linking patient satisfaction to nurse satisfaction (there may be hope yet...LOL!!)

ainz · Jul 31, 2003

Everything is negotiable to some point. A private pay patient will get a bill for the full charges, however, if that person is smart, they will call the business office manager (person who has the expertise and authority to negotiate these kinds of things) and negotiate a price. Many bus. office managers will offer deep discounts, like 50% to 60% of what is owed (even after insurance) for prompt pay.

I work for a for-profit company, never heard of increasing operating costs for a tax break, the tax savings does not make up for the increases in cost.

If you are angry about those "at the top padding their pockets" then get on board with us and let's take some meaningful action to change all of this.

kelman · Aug 2, 2003

Wow, I'm surprised that there's so few of you that know much about billing. I work in an ER. As we discharge or admit each patient, we have to mark all the charges they've accrued and input this into the computer. And, I'll have to admit that I've never seen a pill charge of $25 ever in 25 years. I've seen charges as high as $7-10,000 for a single dose of TPa but a dose of demerol might only be $2.50 for any size dosage (25, 50, 75, & 100mg). Most pills are $1 or less, except for some exotic antibiotics and other meds. Of course, that patient may have gone to a "for Profit" hospital.

In the old days, for an IV start, we'd charge for a bag of IV fluid, the IV start kit, the angiocath, the primary & extention tubing and also, for the procedure itself. Now, we can only charge for the bag of fluid and the procedure. For suturing, we used to charge an "assist the doctor" charge, a charge for the suture tray, each pack of suture, the irrigation saline (may only use 20-50 cc's from 250 ml bottle), the bottle of betadine, dressings, and for a dressing procedure charge. Now, we can only charge for the saline, the betadine, and the dressing supplies.

But just think about all the "unchargable" costs incurred by a hospital. There's security, all the maintenance staff, utilities, actual building maintenance, all the clerical and non-nursing staff (cardiopulmonary, lab, xray, techs, pharmacists) and the cost of keeping staff on-call. How about the cost of maintaining an unbrella Liability Insurance policy (or being self-insured) and the costs of defending the hospital and staff members in liability suits? Every ER has their "frequent flyers" that come in with vague complaints for which the hospital may have to perform "a million dollar workup"--CT's, lab work, sonos, call in procedure technicians, specialist consults, etc--for which you know the hospital will never receive a penny. Like the underage pregnant girls who come in complaining of abd pain so that we'll sono them to check their baby--and it'll turn out they just did it so they could find out the sex of the child! If we have to transfer a patient to a higher level of care hospital and the patient can't pay for the ambulance, the hospital is billed for the transport.

Every hospital that receives any federal monies (ie: medicare & medicaid) is requires to provide a certain amount of (free) care to the indigent each year. And in fact, hospitals in many cases, have insurance or federally mandated price ranges within which they can charge a patient. A earlier reply made an analogy using car repair charges. Well, many mechanics, esp in dealerships have a book that they look into so they can give you the price quote for your repair. For example, you need a starter. That book will tell your service manager what the average time is involved in changing the starter of this particular type of car. If that book says it takes 2 hours, then they can charge you for the 2 hours even if the mechanic has a good day and finishes the project in 1 hour. And their markup on the starter itself can be as much as 50-100%.

I really wish we could make the salaries we should be making comenserate with the acuity of our patients, amount of work we actually perform, the physical risks we take daily, and the level of skill and education we're required to perform our duties. But I can also see that the hospitals are in a real bind too--limits on reimbursements by most insurers and greatly increasing numbers of uninsured citizens on the income side and rising costs of operation on the debt side. Nursing salaries themselves run over 30% at most hospitals.

live4today, RN · Aug 3, 2003

Are we as nurses being asked to "have pity" on the hospitals we serve? I think NOT!

Budgeting a business...any business...is very costly to say the least, however those are the "headaches" that come with being in business, especially when the business can't survive without "human labor" to keep it afloat.....and human labor cost. Trouble is..........nurses have never earned nearly as much as the big wheels running the hospitals, so I take NO PITY on their "budget, budget, budget!!!"

If they can't take the heat, then they should get out of the business!

They should reduce their own fat paychecks and bonuses if they care that much about "budgeting cost" of operating a healthcare business.

I'm sorry........they can't have their cake AND eat it too. :nono: The hard working human laborers can't, so why should they?

I rest my case!

flowerchild · Aug 3, 2003

Quoting ainz: "Everything is negotiable to some point. A private pay patient will get a bill for the full charges, however, if that person is smart, they will call the business office manager (person who has the expertise and authority to negotiate these kinds of things) and negotiate a price. Many bus. office managers will offer deep discounts, like 50% to 60% of what is owed (even after insurance) for prompt pay."

I wish it worked that way here. My best friend is trying to offer 15,000-20,000 to settle a 38,000 hospital bill (private pay). The business office refuses to accept anything less than the 38,000, the full amount. They told my friend that she will have to wait until it goes into collections and then she can offer a settlement which may or may not be accepted. The longer it's in collections the less they will probably accept. Keep in mind this is only for the hospital portion of the hospitalization. She has 15 other bills from Docs, etc that saw her or worked on her in the OR that are billed seperate from the hospital. Total charges for 6 night stay for an emergency appy=$55,000! BTW, she now has a lawyer and is looking for ways to sue-not my idea, but can you blame her?

I have another story for you. My hubby had a heart attack several years ago. I called 911, told them he was having a heart attack, s/s, family hx of heart disease, etc. To make a long story short, it took them SEVEN hours to diagnose him! They did everything they could to disprove me. Needless to say, his heart recieved substantial damage d/t lack of tx. They even took off his EKG and O2 at one point saying he didn't need it, which I myself hooked back up. During his recovery he received a nice MRSA infection in his central line which caused him to be hospitalized for a much longer period than he would have. Then our rights were refused when they refused to let us have access to his chart. They KNEW they screwed up and fought us on getting the records. The only person who stuck up for us was a nurse who I went to school with, I was very proud of her for sticking her neck out, but to no avail. They finally D/C'd him only to have him be rehospitalized d/t overmedication. Well, the hospital knew they had a problem and were probably going to get sued. But, we are not the kind of people to sue, giving the human element the benefit of doubt---BIG MISTAKE! The insurance paid the 80%, the hospital NEVER sent a single bill, they never called, when I called them, I was told the charges to be paid had been removed. I figured they didn't want to mess with us and this was thier way of compensating us for thier major mistakes. WRONG! Exactly seven years later, the amount owed (several thousand $) popped up on our credit report! They waited until the time frame for us to sue was up and then applied the charge reflecting it on the credit report! Since I don't like credit cards anyway (cash is good!) and our home is free and clear, they can sit on it! Those charges can stay on our credit report for seven more years for all I care!

flowerchild · Aug 3, 2003

BTW, my freinds hospital is a not for profit catholic hospital. Seems to me they would be the type of hospital to take a settlement as compaired to the corporate giants. But, NOOOOOO!

flowerchild · Aug 3, 2003

quoted from ainz, "If you are angry about those "at the top padding their pockets" then get on board with us and let's take some meaningful action to change all of this."

I joined the ANA, UAN/AFL-CIO, besides being involved in those, what else can one do? Besides being verbal on BB's like this one to help educate others and oneself? I also frequently call and write gov't officials. Sometimes I feel like what I do helps but not very often b/c it's all bigger than little ol' me. With hospitals in the back pocket of the gov't I just don't feel like we have much chance of changing how the system works.

ceecel.dee, MSN, RN · Aug 4, 2003

Originally posted by mattsmom81
This practice is part of our creeping socialistic system, (and of course we deny having a socialistic system) where the haves/ will do's cover the have nots/will nots.

This bears repeating!