Dec 5, 2019

TeamHealth sent thousands of surprise medical bills in 2017

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Data: TeamHealth letter to senators; Note: Numbers don't include Blue Cross Blue Shield insurers; Chart: Axios Visuals

Physician staffing firm TeamHealth sent thousands of surprise medical bills to patients in 2017, a strategy used to obtain higher payment rates from insurers, according to a letter from the company sent to a group of senators in March, which was obtained by Axios.

Why it matters: These bills can be unaffordable for the small portion of TeamHealth's patients who receive them, and the subsequently high in-network rates raise premiums for everyone.

By the numbers: In the letter, TeamHealth president and CEO Leif Murphy reported balance billing 0.16% of patients overall in 2017, but that includes patients who have government insurance.

  • Among those with private coverage, 0.71% received balance bills. And among those patients who had commercial coverage but were out of network, 3.57% were balance billed.
  • The average balance bill in 2017 was $529, excluding patient cost-sharing obligations — which can quickly add up. But only 30% of patients who were balance billed paid, either partially or in full.

In the same letter, Murphy said TeamHealth provides emergency care to 16 million patients a year, and 26% of its patients have commercial insurance. If .71% of them receive balance bills, that's nearly 30,000 people.

  • "Actually following through and balance billing 3.6% of [out-of-network] treated patients is a substantial amount," said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy.

How it works: "Balance billing yields immaterial revenue for TeamHealth and is not performed with the objective of enhancing revenue," Murphy wrote in the March letter. "Rather ... balance billing is our only available source of contract negotiating leverage."

  • That leverage leads to in-network rates that are multiple times what Medicare pays. TeamHealth collects, on average, $350 per visit by a commercially insured patient, and only $145 from a Medicare enrollee.
  • It collects significantly less from Medicaid beneficiaries and uninsured patients, which collectively make up about half of its patient volume.

Yes, but: TeamHealth says it no longer practices balance billing.

  • "TeamHealth has a longstanding policy against balance billing... To the extent balance billing occurs from a TeamHealth facility, it is rare and unintended," Blackstone's Wayne Berman, head of global government affairs, wrote in a letter to the Energy and Commerce Committee in October.
  • Blackstone acquired TeamHealth in 2017.
  • A spokesperson for TeamHealth declined to comment further.

What they're saying: “Maybe I’m Bambi-esque, but I think holding a gun to patients’ heads to get 425% of Medicare rates just seems wrong. And at some point, enough is enough," said Zack Cooper, a Yale professor.

Go deeper

Physician staffing firm has sued thousands of Tennessee patients for medical debt

Memphis skyline. Photo: Visions of America/Education Images/Universal Images Group via Getty Images

An emergency room staffing firm owned by TeamHealth has filed thousands of lawsuits against patients in Memphis in the last few years, ProPublica and MLK50 report.

Why it matters ... This is a collision of two storylines: the aggressive billing practices of private equity-backed health care companies, and providers' decision to take patients to court to collect their medical debts.

Go deeperArrowDec 2, 2019

The White House is unhappy with private equity's surprise medical billing ads

Photo: Brendan Smialowski/AFP via Getty Images

The White House hasn't weighed in on how to resolve the debate over surprise medical bills, but Joe Grogan, head of the Domestic Policy Council, had some choice words about ads being run by private equity-backed groups:

What they're saying: "The advertisements that are targeting members on this and are being run by the private equity groups who are using the arbitrage on surprise medical billing should make every American and member want to puke," Grogan told Axios.

Go deeperArrowNov 27, 2019

Surprise bills often hit in emergencies

Reproduced from Kaiser Family Foundation; Chart: Axios Visuals

People who are in the middle of a health crisis often are at an especially high risk for surprise medical bills, according to previously unreleased data from the Kaiser Family Foundation.

The big picture: The new data underscore the importance of a legislative solution to help patients who are powerless to protect themselves.

Details: People having surgery or receiving mental health and substance abuse treatment at an in-network hospital are the most likely to experience a surprise bill from an out-of-network provider.

  • Among people with employer-based insurance, out-of-network charges were 50% higher among heart-attack victims than for other diagnoses.
  • 21% of women undergoing mastectomies experienced out-of-network provider charges.

My thought bubble: It’s hard to imagine many patients who are so prepared and insurance-savvy that they could protect themselves from an out-of-network bill in the middle of a heart attack.

Why it matters: It doesn’t take a headline-sized bill to wreak havoc on family budgets.

  • Half of the American people say they would have to borrow money or go into debt to pay a $500 medical bill, or wouldn’t be able to pay it at all.
  • Unexpected medical bills are the public’s top health cost concern, ahead of deductibles, premiums, drug costs, and even paying the rent or the mortgage.
  • People with major medical conditions and chronic illnesses are most likely to experience problems paying their medical bills.

The bottom line: Congress is torn between two competing ideas solving this issue and settling payment disputes between insurers and providers. Each plan has its own implications for premiums and industry negotiations, but for patients, just getting a fix is the most important thing.