Making money
One in five surgery patients can expect a
“jaw-dropping” surprise on their bill, said
Elisabeth Buchwald in MarketWatch .com,
even when the procedure wasn’t an emer-
gency. That’s according to a study of nearly
350,000 people published in February in the
Journal of the American Medical Association,
which looked into what happened to patients
“after having one of seven common elective
operations” between 2012 and 2017. That
these were elective surgeries is notable because
patients “can usually choose in-network
surgeons and facilities.” Still, 20 percent of re-
spondents “ended up owing $2,011 more, on
average,” in addition to their out-of-pocket health-care costs, with
bills often coming from out-of-network clinicians—assistants, an-
esthesiologists, pathologists, etc.—whom the patient never chose.“These practices are an obvious outrage,” said Elisabeth Rosen-
thal in The New York Times, “but no one in the health-care
sectors wants to make the big concessions that would change
them.” It took decades for us to get to this point. Once, hospi-
tals didn’t think they could charge whatever the market would
bear. Then they got entrepreneurial, adding “facility fees and in-
fusion charges.” In response, insurers raised co-pays and deduct-
ibles and shrank their networks of providers. And now, when
doctors decide that insurers aren’t paying them enough, they
simply “stop participating in the network”—and stick patients
with the bill. That’s how “a patient having a heart attack istaken by ambulance to the nearest hospital
and gets hit with a bill of over $100,000
because that hospital wasn’t in his insur-
ance network.”Surprise billing has turned into “a hot-
button issue for voters,” but there’s one big
obstacle to change, said Rachana Pradhan
in KaiserHealthNews.org: doctors. Four
major lobbying groups that support physi-
cians gave roughly $1.1 million to lobby
Congress on surprise-billing legislation.
Capitalizing on the respect accorded to
the profession, doctors “have waged an
extraordinary on-the-ground stealth campaign to win over
members of Congress.” Doctors want arbitrators to determine
the rate insurance companies pay them when they have no deal.
They like a New York state law designed to handle such cases;
that law tells mediators “to base their decisions on the 80th per-
centile of the prices set by the hospital or physician.” Research
suggests that this approach spares some patients the pain of
surprise medical bills, but ratchets up medical costs across the
board. Federal lawmakers “punted on this in December,” said
Caitlin Owens in Axios.com, and “now they are faced with the
same hard problem.” The doctors like mediation, while insur-
ance industry groups have pushed for another system, bench-
marking, that ties reimbursement to typical bills. Patients are
caught in the middle of a dispute that “splits lawmakers not by
party but by which industry group they sympathize with more.”Medicine: An unwelcome surprise from the doctor
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An out-of-network bill can top $100,000.The Christian startup life
Tech entrepreneurs in the Midwest are hustling
to transform cities into tech hubs with a Chris-
tian twist, said Kathryn Joyce in Wired. In Cin-
cinnati, a small group of entrepreneurs started
a lecture series at the fast-growing Crossroads
Church about the “travails of startup life.”
The informal talks turned into workshops,
the workshops became a business accelerator,
and the accelerator spawned a venture capital
firm, Ocean Capital. Now Ocean offers seed
investments of $50,000 for company founders,
as well as “personal and spiritual mentoring.”
The aim is to “instill the notion of Christian
leadership” and help new companies “build
into their DNA a healthier sense of balance.”
One goal: to teach founders that it’s possible
to start a tech company without “putting your
life on hold for five to 10 years, and ruining
your marriage and friendships.”Face-to-face with the taxman
The IRS is coming knocking more often this
year, said Andrew Keshner in MarketWatch
.com—quite literally. As part of an effort to
narrow the $441 billion gap between taxes
owed and taxes paid, the agency expects to
make “at least 800 face-to-face visits” begin-
ning this month, with thousands more later inthe year. IRS audits have been sliding for years,
from a rate of 1.1 percent of individual tax
returns in 2011 to 0.45 percent last year. The
expected home visits will be focused primarily
on “taxpayers who make at least $100,000 a
year” who have not filed their taxes in a least
a year. If the IRS does show up, a tax attorney
recommends asking representatives to leave
their contact information, and “then have a
lawyer or accountant discuss the matter with
the tax authority directly.”‘Kiddie Tax’ revision goes awry
Eliminated just in 2017, the complex “Kiddie
Tax” is back, said Laura Saunders in The Wall
Street Journal. First introduced in 1986, the
rule set the tax rate on most children’s income
at the parents’ rate. The 2017 tax overhaul got
rid of the complex calculations the old Kid-
die Tax required and made children’s income
subject to fixed trust tax rates. That minor
revision proved disastrous for Gold Star fami-
lies, parents with children receiving military
survivors’ benefits. For instance, “one widow
of a Navy officer had a top rate of 12 percent
on her income of less than $55,000, while her
6-year-old son had a top rate of 37 percent on
his survivor’s benefit of about $29,000.” The
previous rules will be reinstated for 2020.What the experts say
Main Stay Therapeutic Farm (mainstay
farm.org) in Richmond, Ill., was founded
in 1984 by equestrian Sara Foszcz and
physical thera-
pist Sandy
Barcus, who
saw a need
to give those
with physical,
behavioral,
and cognitive
disabilities a
safe place to
develop new skills through therapeutic
riding. Main Stay’s instructors, who are all
accredited by the Professional Association
of Therapeutic Horsemanship, give riding
lessons adapted to fit each individual’s
needs. On horseback, children and adults
gain motor skills, learn to balance, and
develop attention, memory, and problem-
solving ability; some even learn to shoot
balls through a basketball hoop while
riding. In 2012, the farm expanded its ser-
vices with an adaptive barnyard that lets
participants learn to interact with animals.Charity of the week
Each charity we feature has earned a
four-star overall rating from Charity
Navigator, which rates not-for-profit
organizations on the strength of their
finances, their governance practices,
and the transparency of their operations.
Four stars is the group’s highest rating.