Ebola: Opportunities for Murky Billing Practices

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Despite the fact that only one person in America has died because of the Ebola virus, citizens, the media and government entities have devoted a massive amount of time, money and concern to the possibility of the disease spreading to other people. The disease reportedly can only be spread through direct contact with bodily fluids containing the virus, and the Centers for Disease Control, along with the White House, have a plan of attack to prevent the spread of the disease.

Though the mass spread of the disease on American soil is improbable, there are still concerns related to residents of West African nations and for healthcare providers who have done work in that part of the world who are trying to stop the epidemic in places like Sierra Leone, Liberia and Guinea.

Preventing potentially infected patients from entering the country is a difficult chore, and there certainly remains a real likelihood that more people who possibly have Ebola will come back to the United States.

Those people who show symptoms are likely to end up in quarantine in a hospital, and that is certain to cost large amounts of money. The treatments themselves certainly are expensive, but just as important are all the other costs associated with fighting mass panic and overcautious approaches.

The public fear of Ebola and the media hype have proven to motivate politicians and some healthcare workers to take measures much further than usual – some necessary, some not. That means that many unnecessary steps will be taken in the care of those potentially inflicted with Ebola, and that means that the potential for overcharging not only exists, but is actually quite likely.



How Much Will It Cost?

While every situation is different, an estimation of the costs associated with treating an Ebola patient can be arrived upon by studying the treatment of Ashoka Mukpo, who contracted the disease while working in Africa as a cameraman for NBC. According to a report on Yahoo.com, attributed to the Fiscal Times, Mukpo’s treatment at the University of Nebraska Medical Center cost in the neighborhood of $500,000. The report went on to say that NBC decided to pay the costs, negating the need for a crowd funding campaign.

medical_billing_advocate-59The one man who did die in America, Thomas Eric Duncan, racked up about the same bill at Texas Health Presbyterian Hospital Dallas, according to Bloomberg.com. Part of the costs included a ventilator, experimental medicine, dialysis, blood transfusions and other drugs. Furthermore, there was a need for security and also expensive disposal of infected trash and garments, plus loads of equipment to make sure that nurses and doctors were protected.

The story cited a quote from Dan Mendleson, CEO of Avalere Health, who said that caring for Duncan probably cost about $18,000 to $24,000 a day. He was isolated from the outside world for nine days and he did not have much money, so the hospital is almost certainly on the hook for paying for the care – though the hospital declined to say publicly that it would do so.

An estimate from NerdWallet stated that Texas hospitals typically charge about $8,176 a day for the treatment of infectious diseases. Andrew Fitch was quoted as saying that because an Ebola patient would be placed in an isolation ward, the cost would increase much more.

Another NerdWallet story claims that quarantine can cost more than $15,000 per day – just quarantine. And the World Bank has estimated that the worldwide economic impact of Ebola could reach $30 billion if the disease continues to grow.


How Do They Get to Those Numbers?

Ebola patients require a wide array of medical services. According to NerdWallet Health’s article, Dr. Fisayo Ositelu said that patients with Ebola are susceptible to dehydration. The constant diarrhea, vomiting and other stomach maladies require constant monitoring as well as constant fluids, and if the number of electrolytes in the body gets too low, there is a big possibility of hypovolemic shock.

medical_billing_advocate-42According to WebMD.com, internal and external bleeding is also possible for infected patients, as well as kidney and liver failure. Dialysis for kidneys is common for Ebola patients.

Medscape.com reported that the replacement of coagulation factors and heparin play a role. Intravascular volume repletion is an important supportive measure, according to the site.

Because Ebola patients’ bodily fluids also carry the virus, expensive precautions must be taken. According to Medscape, urine, stool, sputum and blood – plus anything the patient’s bodily fluids have touched – must be disinfected with a 0.5 percent sodium hypochlorite solution.

The manpower it takes to handle all those bodily fluids and the time it takes to thoroughly clean a private (quarantined) room adds to the high costs of caring for an Ebola patient as well. Blood transfusions and blood pressure drugs also add to the overall costs.

Perhaps the most volatile cost has to do with insurance, covering the people who face potential exposure while doing their jobs. According to Crain’s New York, hazardous material teams would need extra money to cover the risks their employees face.

The story from Crain’s quoted Robert Hartwig, the president from the Insurance Information Institute in Manhattan, as saying that he doesn’t know of any insurance policy that would pay for decontamination.


Don’t Forget the Indirect Costs

The cost for the actual medical care of Ebola patients is certainly expected, and quite transparent. What can get lost in the shuffle are the indirect costs associated with treating individuals who are potentially infected.

Closing off other areas of hospital campuses because of caring for an Ebola patient can eat into the amount of money the hospital brings in. Possible contamination in spots can keep revenue-producing areas closed for cleaning, eating into the bottom line.

medical_billing_advocateOther indirect costs have to do with the aforementioned training of nurses, doctors and other staff in dealing with an Ebola-infected patient. Because those workers are being pulled from their regular routines at work and pulled from departments that depend on their productivity, it means that other workers have to fill in for those shifts – possibly at overtime rates, which can zap a budget quickly.

Any hospital that hosts an Ebola patient – or someone suspected of having the disease but not showing symptoms – will have to maintain an image of calmness in the public eye. Public relations staff, high-ranking administrators and local elected officials will be forced to spend some of their time dealing with media inquiries and projecting an image of having the situation handled. That lost time will take administrators away from projects that have financial implications.

Preventative clothing needs to be purchased to protect staff and doctors. Once they have the clothing to be protected, they need to be trained on how to avoid becoming infected.

The extensive training that many hospitals have been going through in anticipation of an Ebola incident takes up money that weren’t set aside in recent budgets, and therefore must come out of other funds, according to Crain’s New York. For example, the North Shore-LIJ Health System spent $2 million on equipment to protect workers and millions more in training.

Not all expenditures will come from hospital budgets. But individuals will likely still end up paying for the Ebola treatment in some way. Crain’s mentioned that New York City police officers provided security at one hospital with an infected patient, and that money will likely come from the police budget and not from the hospital’s bottom line. Decontamination in some public places could be covered by municipal budgets as well.

Each and every facet that goes into training for, preparing for, and treating an Ebola patient, while often necessary and actually expensive in its own right, is also another opportunity for providers to overcharge, putting the burden on insurance companies, and then of course, the masses that pay for it.

Filed under: Resources, Hospital Bill Review, Healthcare in Politics, Ebola

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