Bill for Ebola Adds Up as Care Costs $1,000 an Hour

Ebola in U.S.
A member of the Cleaning Guys Haz Mat clean up company removes items from the apartment where Ebola patient Thomas Eric Duncan was staying before being admitted to a hospital on October 6, 2014 in Dallas, Texas. Photographer: Joe Raedle/Getty Images

The care provided Ebola patient Thomas Eric Duncan may have cost as much as half a million dollars, a bill Texas Health Presbyterian Hospital Dallas is unlikely to ever collect.

Duncan died today at the hospital, where he had been isolated since Sept. 28. He had been on a ventilator, was given an experimental medicine and began receiving dialysis when his kidney’s failed Oct. 4, the hospital has said. His treatment included fluids replacement, blood transfusions and drugs to maintain blood pressure. There’s also the cost of security, disposing of Ebola-contaminated trash and equipment to protect caregivers.

“It is with profound sadness and heartfelt disappointment that we must inform you of the death of Thomas Eric Duncan this morning at 7:51 a.m.,” Texas Health Presbyterian said today in a statement.

The bill for Duncan’s care may eventually total $500,000 including indirect costs such as the disruption to other areas of the hospital, said Dan Mendelson, chief executive officer of Avalere Health, a Washington consulting firm. Duncan’s care probably cost $18,000 to $24,000 a day, said Gerard Anderson, a health policy professor at Johns Hopkins University’s Bloomberg School of Public Health.

Duncan had been in isolation in the hospital for nine days. “If they recognize that he has no money they will clearly just write it off as charity care,” Anderson said in a telephone interview yesterday before Duncan’s death was announced.

No Insurance

Duncan came to the U.S. from Liberia on Sept. 20 on a tourist visa. He had no health insurance to pay for his care, said the Reverend Jesse Jackson, the civil rights advocate, who traveled to Dallas at the request of Duncan’s mother.

Spokesmen for Texas Health Presbyterian and for the Liberian embassy in Washington declined to discuss who would pay for Duncan’s care.

Duncan is the first case of Ebola diagnosed in the U.S. Emory University Hospital in Atlanta and Nebraska Medical Center in Omaha have also treated Ebola patients, three of whom have been released after recovering. A fourth patient is under care in Omaha and a fifth in Atlanta.

Neither of the hospitals would comment on the cost of treating those patients. Kent Brantly, the first person to be transported from Liberia to the U.S. for care, was covered under health insurance provided by his charity, Samaritan’s Purse, said Todd Shearer, a spokesman for the group.

SIM’s Coverage

Two other aid workers, Nancy Writebol and Rick Sacra, went to Liberia with the Charlotte, North Carolina-based missionary group SIM. They are covered by the group’s health and workers’ compensation insurance plans, and SIM plans to pay their $25,000 deductibles, said George Salloum, the group’s vice president for finance and operations. Writebol’s evacuation from Liberia was covered in full by one of SIM’s insurance carriers, Aetna Inc., he said. He’s still waiting for bills from other carriers, whom he declined to name, and said he didn’t know what the hospital care cost.

“The hospitals have not disclosed that information to us,” Salloum said in a phone interview. “I’m very anxious to find out, personally, just wondering what they’re charging for that kind of care.”

Emory and Nebraska are known for their expertise in exotic diseases and careful isolation of infectious patients. Texas Health Presbyterian has no such pedigree.

Hospital Rank

It is ranked the fifth-best hospital in the Dallas-Fort Worth region and 15th-best in Texas by U.S. News and World Report. Duncan arrived there in an ambulance on Sept. 28, after being initially sent home two days earlier from the emergency room with antibiotics. The hospital has blamed a communication failure in its electronic record system for Duncan’s initial release.

“They have an excellent reputation in the community” and “very good infectious disease physicians,” Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council, a trade group, said in a phone interview.

Anderson, who is a former federal health official, said that as a foreign citizen Duncan wouldn’t have been eligible for any U.S. health programs such as Medicaid, for low income people. Texas hospitals charge $8,176 per day on average for treatment of viral illnesses, including exotic diseases such as West Nile virus and Dengue fever, said Andrew Fitch, a health-care pricing expert at NerdWallet, a San Francisco-based company that provides consumer finance and health data.

That figure “is actually probably on the low end” for Ebola, Fitch said in a phone interview. “The isolation ward would bump up the charge a lot.”

Area Costs

Health care generally is more costly in Dallas than in the rest of the country, according to the Dartmouth Atlas of Health Care, a project of Dartmouth University that tracks regional variation in spending by Medicare, the U.S. health insurance program for the elderly and disabled. Medicare beneficiaries in Dallas cost about $11,484 on average in 2012, placing the area within the 90th percentile for the U.S.

Isolation procedures can include placing patients by themselves in rooms capable of negative air pressure, to prevent microorganisms from escaping, said Pritish Tosh, an infectious diseases physician and researcher at the Mayo Clinic in Rochester, Minnesota. Physicians and nurses treating the patients must don gloves, gowns and masks with eye protection before entering the room and dispose of the gear afterward, he said.

Intensive Care

That can roughly double the cost of standard treatment in an intensive care unit, Anderson said. If a U.S. outbreak occurs, something federal health officials say is unlikely, the cost of care may fall as hospitals gain experience and streamline procedures, said Jeffrey Rice, CEO of Healthcare BlueBook Inc., a Brentwood, Tennessee, company that calculates health-care prices for consumers.

There is no approved cure for Ebola, though some patients have received experimental medications. Standard treatment includes supportive care to maintain body fluids, replace blood and fight off opportunistic infections.

The Ebola outbreak originated in West Africa, where it has infected 8,033 people, killing 3,879, primarily in Liberia, Sierra Leone and Guinea, according to a report today from the World Health Organization.

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