Share of Cost, Kwashiorkor in California Epidemic of upbilling?
You’ve seen the starving and malnourished third world toddlers on TV, their distended bellies and plaintive cries used by charities for decades. But you might be surprised to learn that the condition, called kwashiorkor (a Ghanaian term for ‘weaning sickness,’) is suddenly rife among senior citizens seeking treatment at certain California hospitals. Either that, or a hospital chain is soon going to be charged with “upcoding” ailments to goose Medicare reimbursements. That’s the conclusion of an investigation by Lance Williams, Christina Jewett and Stephen Doig of CaliforniaWatch.
According to the story, 288 Medicare patients age 65 and older, (16.1 percent), received treatment for kwashiokor in 2009 at Shasta Regional Medical Center in the northern city of Redding. That’s 70 times the state average. Nearby hospitals report no such spike. About a mile from Shasta Regional, Mercy Medical Center reported just 12 cases, a rate of 0.2 percent. At Desert Hospital in Victorville, 573 miles to the south, the rate was 9.1 percent, 39 times the state average.
Are these clusters the first signs of a geriatric epidemic? Perhaps. But the clusters do have one thing in common. Of the 10 California hospitals that reported the highest malnutrition rates among Medicare patients, eight – including the top four – are owned by Prime Healthcare Services, a southern California-based hospital chain.
The company so far is accusing the Service Employees International Union of spreading misinformation in an attempt at extortion, though the figures cited in the story were generated independently.
Treating malnourished patents is generally more costly than curing those with a single ailment. That’s why Medicare provides hospitals with $2,700 more for treating those with what Medicare terms a major complication, like kwashiorkor, compared to patients treated for a stroke.
While this particular case will no doubt be tied up in regulatory actions and the courts for some years, it shines a light on various issues as the nation seeks to reel in healthcare costs. If it takes an internal contract dispute for possible malfeasance to emerge where are the regulators entrusted with safeguarding the public purse? Is this instance of upbilling — the process by which hospitals charge and are repaid for more expensive procedures than what was actually delivered — just the tip of the iceberg, exposed by the use of a bizarre illness? And as policymakers consider reducing Medicare repayment schedules, will upbilling become more pervasive as the medical industry seeks to maintain its cash-flow? Stay tuned.