Hospital-insurer tug of war leaves patients in middle

The Washington Post reports on a health care battle between a hospital and insurers that is leaving patients caught in the middle. At Bayonne Medical Center in New Jersey, Horizon Blue Cross Blue Shield delivered letters to patients at the hospital "warning that the patient would face a huge hospital bill if he did not leave right away." The hospital turned the couriers away. "The hardball tactics being used to pry patients from their sickbeds illustrate the colliding financial interests that pervade U.S. health care. It is a tug of war over where patients are treated, who decides how much care they receive and -- fundamentally -- which parts of the health-care industry gain or lose when people become ill."

The battle playing out in Bayonne has particular relevance as Congress tries to rewrite the rules that govern health care nationwide -- with hospitals, insurers, doctors and other stakeholders descending on Capitol Hill to angle for advantage." The health reform bills pending in Congress "would shift the system's balance of power that has evolved over decades," but the Bayonne battle "also hints at the limits of what federal health-care changes would accomplish; none of the bills would legislate away the specific business practices that have escalated into a full-scale brawl between the city's only hospital and New Jersey's largest health insurer, Horizon Blue Cross Blue Shield" (Goldstein, 10/9).

The Indianapolis Star reports on a Bloomington Hospital, which has a low readmission rate for heart attack patients. "Only 11 hospitals in the U.S. have a lower readmission rate for heart attack patients than Bloomington Hospital, according to a Medicare review of 4,400 hospitals' records from 2005 to 2008."

"The federal government thinks that if more hospitals are like those facilities, patient care would improve and taxpayer money would be saved. One in five Medicare patients returns to the hospital within a month of being discharged, according to the Centers for Medicare and Medicaid Services, which released hospitals' readmission rates this summer." The health care reform bills being considered in Congress would address the problem by reducing "Medicare payments to hospitals with high readmission rates. … The hospital industry has agreed to the readmission reimbursement penalty as part of its commitment to accept $155 billion in cuts over the next decade -- its share of the cost of providing health coverage to more Americans" (Groppe 10/9).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.