Tuesday, September 22, 2009

How to be persuasive?

It is striking to me that the SEIU continues to think it is persuasive to hire a billboard truck that adds to the pollution and congestion of Boston streets to spread its message. It is also curious that it thinks that parking the vehicle in front of the hotel in which our volunteer community leaders are holding their annual meeting will be useful. And then, too, there is the trash barrel overflowing onto the street with its leaflets.

What's even more curious is the idea that the union apparently views criticism of ER doctors' billing practices as an effective way to gain support.* Especially since they were mighty silent about some controversial CEO compensation at a hospital in which they already have organized the workforce: "Representatives of SEIU 1199, the union that represents many of Boston Medical Center’s workers, declined to comment."

Oh, I forgot. This is not about organizing workers. It is about conducting a corporate campaign.

What's next? Demonstrating at the grand opening of the newly improved hospital in Needham, the one where it opposed the bond issue to pay for a project that has widespread community support? What a moving case that would make.

*Note: The physicians are not employees of the BIDMC or the other hospitals cited in the story.


Anonymous said...

Oh, so they're baaack! The truck is hilarious.

(Glad I'm) nonlocal MD

Anonymous said...

Well, these fees are outrageous. Am I supposed to wait till 8am with my heart attack or a broken arm?

Anonymous said...

No, if you are having a heart attack or broken arm then $30 isn't going to change what you do. The purpose of the $30 is to prevent all of the night owls from showing up at 3:00 am with the sore knee they have had for a month or the cold that just won't go away and is keeping them up. Night shift work is difficult and bad for your health. Many physician groups have had to add extra night shift coverage because people now show up at any time with any complaint. I applaud them for saying, "You want to come at 3:00 am, you have to pay for the atypical service time." I suspect all of the people complaining would have no problem paying a plumber $30 extra bucks to repair their burst pipe at 3:00 am.

Anonymous said...

Actually, I think that the patient is not likely to see this charge at all, for in the vast majority of cases it will be paid by the insurance company or Medicare.

Anonymous said...

Mr. Levy: this is just the kind of logic that got us all into this mess called American healthcare. Everything is ultimately paid for by patients, through insurance premiums, copayments, deductibles, and taxes. These $30 come from my premium and my taxes - there is no other source for them to come from. The insurance cartel will not dip into its profits to cover your fees.

Anonymous said...

Sorry, but wrong on the last point. The insurers approved these fees in their contracts with the MDs.

Keith said...

What other profession is not paid shift differentials for working at night? Nurses often are compensated more for working the night shift and it is disruptive and stressful to work nights very often. If you need a plumber off hours, my guess is you end up paying more.

SEIU obviously has its sights on you, but it raises the issues of what your hospital is doing to impede union organization of your employees. And some of the issues they raise about charitable activities and the accounting of these are very legitimate in my mind, though obviouly done in the spirit of retaliation.

Hospitals, such as yours, have done financially very well over the past few years, during which the charitable contributions have fallen and management salaries have soared. More the model of a for profit endeavor than a non profit hospital. And I also noted one of your board members was caught up in the Madoff scandal, so at least one rich white guy is on your board (maybe not rich for long and has now apparently resigned). You had previously noted that I made a broad and inaccurate generalization, but I will bet I am not too far off as to your board composition being largely men with big fat wallets. After all, what better mark of success and interest in community health and well being than being rich!

Anonymous said...

To Keith,

To your point on management salaries. To say they have sored in resent years I would say is incorrect. If you looked at a comparable position in the forprofit world you would see they make quite a bit more. Additionally management here has taken an across the board pay cut this year.

Richwlf said...

Shift differentials do make sense. Anyone who has covered a night knows that working at 2AM is not the same as working at 2PM. Providers who are willing to stand watch at night deserve a differential in their income for what it does to their health and their families.

The public views emergency care 24x7 as a right. Our government has created laws making it a mandate. Yet neither provide an answer as to how can one provide highly trained, qualified providers, 24x7 without billing for the work.

The after hours code is almost never reimbursed. It generates little income and is has no effect on the vast majority of patients. It just is a fair way to reflect the work and effort for the people who do a hard job. Emergency physicians who hold on to this code do so out of principle not out of greed.

Consider that Massachusetts reimbursement for emergency care is at the low end of the spectrum for the United States. Consider that this code has virtually no financial impact on health care costs. Yet the SEIU chooses this as a target rather than the dramatic rise in copays for emergency care set by the payors or the gross inequities in reimbursement for care based on market share rather than quality or safety.

Change starts at home. If SEIU is sincere in the desire to stop shift differentials and reimburse patients for this, why not start with all the SEIU affiliated nurses who have received the same shift differential thanks to union negotiations and with all the emergency physicians who use this code at the hospitals they partner with?

skemper said...

Am I crazy to think that people wouldn't have to use the emergency room for chronic problems if they were receiving proper health care in the first place?

ManxMamma said...

skemper, far to often people present at the ER with trivial, inappropriate issues - not necessarily chronic problems.

Keith - this institution has done nothing to prevent employees from forming a union. We are quite happy as we are without padding the pockets of the SEIU management!

Mark Graban said...

I really don't understand the reasoning behind the fee for two reasons:

1) Does the fee really change consumer behavior the way you want


2) Why is worker pay so tightly tied to the price you charge the payers?

If the night fee is supposed to drive consumer behavior AND that fee is not seen by the consumer, how does it drive them to come during the day?

Let's say a movie theatre wants to spread out its workload, so it offers a discount for a matinee (or you could look at it that they charge a premium for the 7 PM and 9 PM shows). If you have lots of flexibility in your day and/or you are price sensitive, you can choose to go during the day. The lower pricing the day modifies customer behavior in some cases there.

I agree with the earlier commenter that this type of price hiding (my insurance pays for it, so I don't care or don't even know about it) is part of the problem and a fee like this adds to that. Sure, the payers agreed to it, but that doesn't mean it's right or that it will be effective in meeting your goal of getting discretionary E.R. users to come during the day.

Also, why the necessary connection between what you pay your staff and what you charge the payer?

Sure, the night shift staff should get a premium.

But why charge me more as a customer?

Do I pay a higher price when my Chevy happened to be built on the night shift, where the workers have a shift premium? No, GM spreads that night-shift cost across all products. Admittedly, that's not a perfect parallel because it's a product and not a service like a hospital.


Anonymous said...

Mark, here is a late-breaking story on the fee issue, Sept. 24

By Elizabeth Cooney
Globe Correspondent

In the face of criticism from a union of health workers, a physicians group has decided to drop its late-night surcharge for patients who come to emergency rooms after 10 p.m. at five Massachusetts hospitals.

Harvard Medical Faculty Physicians said today it would no longer add $30 to bills for emergency care delivered between 10 p.m. and 8 a.m. The fee was attacked earlier this week by a health-care union that is trying to organize workers at Beth Israel Deaconess Medical Center, where the doctors are affiliated. The other affected hospitals are Beth Israel Deaconess-Needham, Nashoba Valley Medical Center in Ayer, Saint Vincent Hospital in Worcester, and Milton Hospital, which dropped the fee earlier this month.

"The general feeling is if it could cause one single patient not to seek emergency care, then we don't want it," Dr. Richard Wolfe, chair of emergency medicine at Harvard Medical Faculty Physicians and Beth Israel Deaconess, said after talking with physicians at the five hospitals. "We've instructed our billing company to no longer bill for that code."

The union called for refunds.

"It's good that when this indefensible practice was called to the public's attention that Beth Israel stopped it," Mike Fadel, executive vice president of Local 1199 of the Service Employees International Union said in a statement e-mailed to the Globe. "These fees never should have been charged in the first place, so if they want to do the right thing, they now need to refund the fees to the patients who were charged."

Patients with insurance might not have seen the fee. The government Medicare and Medicaid programs do not pay doctors who bill such a fee, nor do private insurers Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Tufts Health Plan, and Aetna, spokesmen said today. If insurers reject the fees, the patient cannot be charged under a state law that forbids what is called balance billing.

The few patients without insurance who pay their own bills might have been charged what would represent less than 5 percent of a total charge for emergency care, Wolfe said. David McKenzie, reimbursement director of the American College of Emergency Physicians, said the late-night fee is commonly billed throughout the country, although the group does not track such claims. Doctors at none of the other major Boston hospitals charge the fee.

Wolfe compared the fees to different rates that nurses are paid for working late shifts, defending them as a way to reward people willing to work overnight, especially at a time when emergency physicians are in short supply.

"It ends up being a morale issue to support the people that are doing the work," he said.

Mark Graban said...

Paul, thanks for the update. I was in the Longwood area today and caught a glimpse of the union annoying-mobile driving by (back to the point of your post).

I still think it seems like a non-sequitor when the spokesman says basically "well we want to pay a night differential to the staff."

Then BIDMC is free to still do so... it's not like this $30 fee was going into a tip bucket that was divided up like restaurant tips.

The fees and paying more for keeping staff morale up aren't necessarily coupled.

Anonymous said...


Just to clarify again. This is not about BIDMC and what we pay our staff. MDs are not hospital employees. This issue is solely about what the physicians' group (a separate corporation from BIDMC) was billing and what it pays.

But, as you note, the purpose of my post was not to cover that issue: It was to make clear that the issues raised by SEIU have nothing to do with the merits of organizing the hospital's workers.

Anonymous said...

Last time I looked, people don't get sick on an hourly schedule, and medicine was always understood from day one of medical school to be a 24/7 proposition when one is on call. This is the essence of our profession. Medical patients decompensate in the middle of the night, surgeons have to remove appendices in the middle of the night, orthopods have to treat trauma in the middle of the night. Are you going to give a shift differential to all of these?
If physicians want to behave like hourly workers, then they will eventually become hourly workers. Then don't whine about it.