By Dr. Paul Ehrlich
Great timing. An article on the front page of the Sunday New York Times on colonoscopies happened to coincide with the fact that I finally received an answer to a question eight weeks after I asked it. The Times piece was about colonoscopies and the part they play in our inflated national health care bill. Funny, I always thought doctors were looking for signs of cancer during this undignified procedure. It turns out they were also looking for gold.
A procedure that costs a few hundred bucks in other developed countries, runs anywhere from about $2800 in Cleveland, Milwaukee, and Salt Lake City to about $8500 in New York City. The gastroenterologist who’s responsible for actually looking for signs of disease actually makes less than the anesthesiologist who either administers general anesthesia—a largely unnecessary excess—propofol, which renders you unconscious just for the length of the scoping, or a bit of Valium. (Take note, music fans—propofol was the drug that allegedly did in Michael Jackson.) But don’t cry for the gastroenterologist. He may be a partner in the venue itself, which, like a hospital, can charge a whopping “facility fee.” These colonoscopy centers can provide a 100% return on investment in less than two years.
So, what does this have to do with allergies? One word: Xolair (or maybe two words, since the generic name for Xolair is omalizumab). Allergists use Xolair, also known as the anti-IgE antibody, to treat very severe cases of asthma. Xolair must be injected slowly, it is often painful for patients, has side effects and therefore requires observation, and is also incredibly expensive—upwards of $1200 per shot. After my staff gets through with the elaborate coding, arguing with insurance companies, and so forth, I end up giving it practically at cost.
With this in mind, when I was approached by hospitals I am affiliated with to take my Xolair patients for their injections, it made sense. They would assume the entire paperwork burden and I wouldn’t lose space in my waiting room for observation, or indeed my own precious capacity for paying attention to patients who are receiving a powerful drug. But then I asked the question, “What do you charge to give one of these shots?” Eight weeks later, I got the answer: $5500.
I’m not doing it. Certainly the red tape is extraordinary. But these are my patients, and I don’t want to lose the continuity of treatment and observation while they report to another facility even if I don’t get paid. Would I like to split the difference between what I charge and what the hospital charges? Sure. And if the insurance companies had any sense they would find a happy median. I even know where they can find the money–they can just make up the additional payments to me out of their savings in other medications and emergency treatment. Regardless, no more referrals from me.