The Time Magazine Article and the President’s Response

By Len Zwelling

                The Bitter Pill by Steven Brill was an eye-opening article in Time Magazine for some. But what was in this piece should have come as no surprise to anyone at MD Anderson.

                My interpretation of the Brill article is:

1.       Charges for hospital care are very high

2.       The charge masters that guide the charges are arbitrary and the charges on them are not based on costs

3.       What hospitals actually get paid for identical service can vary by at least an order of magnitude depending on who, if anyone, is actually paying the bill

4.       In this system, these non-profit providers are showing very healthy margins

5.       The leaders of these institutions are making a great deal of money

                MD Anderson is just one of many institutions to which these 5 points apply. Furthermore, MD Anderson did not invent the system. Berating the leadership of Anderson for clinging to the model that results in these 5 conditions should surprise no one. The only real questions left are how long can this go on and is this the way we as faculty want to see Anderson operate?

                As for the how long question, my guess is not much longer for the system is going broke and payers of all kinds want some relief from the ever-escalating bills they are being asked to pay. As for whether or not the Anderson faculty appreciates all of this and acquiesces to it, I am not the one to ask, but I see no one objecting in a way that would change anything.

                On March 1, President Ron DePinho responded in an email to all about the Time Magazine article in which MD Anderson had a prominent role. He discussed our goal of ending cancer. He discussed our investment of institutional resources in research and education. He discussed our non-profit status. He discussed the complexity of pricing and billing in the health care arena. He claimed that we have programs aimed at containing medical costs.

                Unfortunately he really did not address any of the major issues of the article.

1.       Why are hospital charges so high?

2.       What informs the numbers on our charge master? Is it costs or is it what we can wedge out of payers like Medicare and private insurance?

3.       Why does the same service yield completely different income depending on who is paying?

4.       Can you call any enterprise making as much money as we do non-profit?

5.       Why are the salaries at the top of our institutional food chain so high at a time when all we have heard about is the need to generate more revenue or does one explain the other?

                It is very nice that Dr. DePinho took the time to write an answer to the Time Magazine article. Now he might consider addressing the main points in the article and how they apply to Anderson and whether changes are indicated.

Leonard Zwelling