Becker's Spine Review

10 SPINE Colorado Supreme Court rejects hospital's bid to enforce $229K spine surgery bill By Carly Behm A spine surgery patient will not be on the hook for a $229,112 med- ical bill at Westminster-based St. Anthony North Health Campus, the Colorado Supreme Court ruled May 16. In 2014, Lisa Melody French had a pair of spine surgeries at St. Anthony, part of Centennial, Colo.-based Centura Health. St. Anthony cannot sue Ms. French for payment of the bill because she had no knowledge of nor consented to the hospi- tal's chargemaster, a list of billable services and items for patients or their insurer, the court ruled. "Hospital chargemasters have become increasingly arbitrary and, over time, have lost any direct connection to hospitals' ac- tual costs, reflecting, instead, inflated rates set to produce a targeted amount of profit for the hospitals after factoring in discounts negotiated with private and governmental insurers," Justice Richard Gabriel wrote in the court's opinion. Ms. French claimed she signed a contract in which she agreed to pay "all charges of the hospital" for her care, but St. Anthony estimated it would cost her $1,337 out of pocket and her insurer would cover the rest. Instead, the bill was $303,709. She paid $1,000, her insurer paid $73,598 and the remainder was disputed. But after surgery, Centura said it misread Ms. French's insurance information and only then discovered she was an out-of- network patient. Centura then billed Ms. French $229,112 and sued her for breach of contract to collect. Attorneys for the patient argued a hospital representative mistakenly told her that her insurance was in network, the contract she signed was ambiguous and she should not be responsible for paying the $229,112. St. Anthony claimed it is the patient's re- sponsibility to understand their insurance and determine in-network status, but the Supreme Court rejected the hospital's ar- gument, overturning a Colorado Court of Appeals ruling in favor of the provider. The Supreme Court ruling said the con- tract Ms. French signed does not reference the hospital's chargemaster and leaves the meaning of "all charges" as ambiguous. Barak Richman, a law and business admin- istration professor at Durham, N.C.-based Duke University, said the ruling would en- sure patients have informed consent be- fore incurring charges, The Denver Gazette reported May 16. The ruling would not prevent hospitals from making emergency decisions, he told The Gazette. n Unnecessary spine cases spur class action lawsuit By Carly Behm A class-action lawsuit alleges two for- mer neurosurgeons from Renton- based Providence Health & Services Washington harmed hundreds of patients through unnecessary cases. Daniel Elskens, DO, Jason Dreyer, DO, and Providence St. Mary Medical Center in Walla Walla, Wash., are all named as defendants in a complaint filed May 13 in the Superior Court of King County. e alleged unnecessary procedures in- cluded spinal fusions that le patients with permanent damage. A 59-year-old woman saw Dr. Elskens for lower back pain but was recommended for neck surgery. e April 2016 procedure damaged her vocal cords, and she currently cannot speak. Dr. Dreyer in 2017 did an additional spinal fusion that resulted in ad- ditional damage, the lawsuit said. Another patient went to Dr. Dreyer for lower back pain and was also recommended for cervi- cal surgery instead, aer which he was le unable to work, the lawsuit said. Later, Dr. Dreyer performed lumbar surgery on the same patient that allegedly le him with permanent nerve damage. A 60-year-old woman and her husband are also represented in the lawsuit. Dr. Dreyer operated on the woman in 2015 for neck sore- ness but allegedly didn't recommend non-sur- gical options first. A series of spine surgeries in the following years allegedly led to perma- nent damage, the lawsuit said. Providence in April agreed to pay $22.7 mil- lion to resolve allegations that it defrauded federal healthcare programs with the un- necessary spine surgeries. Four Washington residents are named as plaintiffs in the class-action lawsuit, but more patients are expected to join the suit, attorney Bill Gilbert told Becker's. He said in a May 27 phone call that he has spoken with other spine patients who were allegedly injured by unnec- essary procedures. "is is just senseless," Mr. Gilbert said. "It's just greed. … at's such a huge betrayal. We're taught to trust our doctors, and we should be able to trust [them]." A spokesperson for Providence said the two surgeons were placed on leave and le the health system in 2017 and 2018. "Although the events in question occurred at one Providence hospital in the southeast re- gion of Washington state, we initiated a broad and comprehensive internal review of our policies, practices and procedures to ensure robust compliance with government require- ments and the delivery of high-quality care," the spokesperson said in a May 27 email to Becker's. "is unfortunate episode has rein- forced our commitment to continuous quality improvement and highlighted the importance of our mission." n

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