Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, December 13, 1993 TAG: 9312130078
SECTION: NATIONAL/INTERNATIONAL PAGE: A-4 EDITION: STATE
SOURCE: STACEY BURLING KNIGHT-RIDDER/TRIBUNE
DATELINE: PHILADELPHIA LENGTH: Long
It also has refused to pay $10,000 in surgeons' fees at Children's Hospital of Philadelphia, where the twins were separated in August.
Children's says the state's Medicaid office did agree to pay part of the hospital bill in Philadelphia - originally about one-fifth - but has yet to send any money. As of last week, the bill at Children's totaled nearly $480,000.
In the era of health-care reform, Indiana Medicaid's handling of the Lakeberg case is a stark example of passing the medical buck - something we can expect to see more of as health-care money gets tighter.
Insurers of all sorts will be more likely to deny bills whenever they can, said Mark Pauly, a health economist at the University of Pennsylvania's Leonard Davis Institute of Health Economics.
"My best guess is that this is sort of a foretaste of what people in general might experience," he said.
The Lakeberg babies, whose parents, Joey and Kenny Lakeberg, are from Indiana, were born joined at the heart and liver. They spent six weeks at Loyola before being transferred to Children's, where doctors separated them. One of them, Amy, died during the operation. The other, Angela, remains in Children's intensive-care unit.
The twins' family is covered by Medicaid, the state and federal insurance program for the poor.
Indiana Medicaid, which is facing a shortfall of a half-billion dollars over the next two years, refused to pay Loyola's bills because the hospital did not seek advance permission to care for the twins.
Medicaid originally agreed to pay the Philadelphia surgeons who separated the girls, said Sarah Jarvis, a Children's spokeswoman, but has since denied their bills because the procedure was "experimental."
James Verdier, Indiana's Medicaid director, said the state never agreed to pay for the surgery, which he called a "highly risky, highly expensive, highly unlikely-to-be-successful procedure."
The Lakeberg case has been controversial from the start. Joey Lakeberg chose to bear the twins at Loyola because other doctors had recommended she abort them. She and her husband, Kenny, brought the babies to Philadelphia after doctors in Chicago said it would be too risky to separate them. Doctors there agreed to do the surgery, knowing that one of the girls would die and the other had a minimal chance of long-term survival.
After the surgery, Kenny Lakeberg drew more attention by admitting he had used money donated for his daughters' medical care to buy cocaine. He is in prison for failing to appear at a probation hearing. He was on probation for slashing his cousin's hand with a butcher knife.
Jonathan Muraskas, Joey Lakeberg's neonatologist at Loyola, said the Lakebergs could have gotten equivalent care at the University of Indiana Medical Center in Indianapolis. He never questioned why they came to Chicago.
"I never even gave it a second thought," he said. "I just think about the patient. I never even think about the economics."
Verdier said hospitals throughout the United States are complaining that insurance companies of all sorts, including Medicaid, don't pay them enough money. Increasing numbers of insurance companies are putting restrictions on which hospitals their clients can use.
"That is life in the United States health-care system," he said.
Uwe Reinhardt, who teaches political economics at Princeton University, sees the Loyola denial as an example of bureaucracy at work.
"America has the most bureaucratic health system in the world, bar none," he said. "Whether it's public or private doesn't make any difference, and I think, in part, this bureaucracy exists to allow people to wrangle out of things like this."
Michael Maggio, a Loyola spokesman, said, however, that Loyola and its doctors did not expect the Lakebergs to pay the bills.
"As far as we're concerned, the case is closed monetarily," he said.
Loyola will "absorb" all of its Lakeberg bill. Children's, too, will absorb a large part of its bill, which is 25 percent to 30 percent higher than its actual cost.
This means the hospitals' donors and their patients who have private insurance will end up paying for the Lakeberg babies' surgery and care. They pay, as well, for many other patients who have no insurance or whose insurers refuse to pay. Ultimately, all patients with insurance pay higher premiums because of this system.
"Somebody ends up paying," Loyola's Maggio said. "That's what the whole [health-care] debate is about."
"In fact," said Alan Hillman, director of Penn's Center for Health Policy, "those of us who have insurance and go to Children's are paying a little bit extra for everything we get there to pay for the Lakeberg situation."
Economists point out, too, that the actual cost of caring for one or two additional infants is far below the hospitals' bills. And Children's benefited enormously, they say, from publicity about the case.
Still, such cutting-edge cases are expensive and, as insurers become tighter with their money, hospitals are finding it harder to shift costs around. Insurers are getting tougher about what they'll cover for their own clients, and they certainly don't want to pay extra for somebody else's. As a result, hospitals will have to be more careful who they treat, Pauly said. They may be "less willing to accept challenging or questionable cases, knowing that they're going to be stuck with the bill."
Neither Children's Hospital nor Loyola officials expressed anger at Indiana Medicaid.
"They denied on the basis of what the law enables them to do. There is no blame to be placed," Maggio said. "We are not upset at Medicaid."
His hospital does not plan to challenge Indiana's decision.
"The cost of going after it would probably cost far more than what it would take to forget about it," he said. "Who are we going to sue? The government? What are the chances of winning and how long would it take? Probably I'll be retired before a decision is reached."
by CNB