Updated on: November 29, -0001

The $6,000 Jaguar or Defibrillator

By
Original story posted on: March 26, 2013

The village in which I live is peopled, in large part, by folks whom demographers describe as "extremely high net worth." These are, as the song goes, "people who live on the hill." And when they cruise down into town in their luxury sedans or well-maintained classic automobiles, it's a sight to behold. Recently, I was looking at a vintage Jaguar — a convertible. For sale. And the price seemed reasonable: slightly more than $6,000.
 
The $6 grand figure has stayed with me. Why? Because, recently, when talking to Ron Hirsch, MD, vice president at Accretive Physician Advisory Services, he mentioned that for Medicare beneficiaries, the 2013 inpatient deducible is $1,184, payable once in each 60 day period if the patient is hospitalized. On the other hand, if a patient is placed in outpatient status, the patient is responsible for a $147 deductible and 20% of the approved Medicare amount for all other services.
 
"This means that the breakpoint at which beneficiary outpatient obligation exceeds the inpatient deductible is when the outpatient services Medicare-approved amount exceeds $6,000, exclusive of charges for self-administered medications," writes Dr. Hirsch in an upcoming article in RACmonitor e-news.
 
Dr. Hirsch, continues and says that what is rarely discussed by providers, and totally ignored by CMS, is the increasing beneficiary liability when CMS moves a surgical procedure from status indicator C, which means the procedure can only be performed as an inpatient and billed as a DRG, to status indicator T, meaning it can be performed as an outpatient, billed as an APC (or an inpatient, depending on the clinical circumstances.)  
 
"As noted earlier, if the APC payment exceeds $6,000, the patient will pay more out of pocket if the surgery is performed as an outpatient rather than as an inpatient, " Dr. Hirsch concludes.
 
If my father were still around, I'd rush to phone him and break the news to him. But as a recently enrolled Medicare beneficiary, there's no one but me to call. And right now, I'm still thinking about that Jag.
 

Gracielinda Prescott

This email address is being protected from spambots. You need JavaScript enabled to view it.