Sunday, June 30, 2013

The Infinite Loop

Doctor's can't help fix the health care cost problem because they are kept uninformed about prices or (worse) not allowed to disclose prices to patients or journalists (or health care researchers) once those prices become known to them lest they lose their job.

So, for example, there might be a technology a doctor wants to use to make a diagnosis on one of his patients.

Later he learns that his patient was charged many thousands of dollars for that simple diagnostic test because his patient informs him that the insurance company considered the test "unproven or experimental" and refused to pay for it.

Not only is the charge for the test exorbitant relative to the work required to perform it, but the doctor also learns that every local insurer will not pay for the simpler test he ordered but will pay for an invasive surgical procedure to gather the same exact same data at ten times the cost.

What should the doctor do now?

Should they refer future patients for the diagnostic surgical procedure that pays him and his employer well yet costs the patient very little, or should they do the least invasive and safest test to gather the data knowing their patients will be left with a hefty overpriced bill that will not be covered by their insurer?

For the solution to this problem, I'd refer the reader to the first sentence of this piece.

* * *

In the past when the majority of doctors were independent from large health care systems, doctors could advocate for their patients and move them to other centers that offered cheaper prices or had superior services.  Now it is estimated that nearly 75% of physicians will be employed by hospitals or large health care systems by 2014.  This may sound reasonably benign and irrelevant until patients contemplate what they are trusting their doctors to do.  

If the issue of quality and price transparency are important parts of our health care reform discussion, then another solution for reform than our present construct will have to be developed.

After all, with the passage of our new health care law (and its "accountable care organization" construct), it is becoming crystal clear that we have approved a system that perpetuates the impossibility of doctors serving as true advocates for their patients.



Lisa said...

The patient can call the insurer and request pre-certification for any test or procedure. The are likely to get push back on the request, but it is usually worth standing your ground.

Anonymous said...

Dr. Wes,

This policy of keeping prices secret originates with the hospital who, in turn, threatens a physician with the loss of his job if he transmits the cost of the procedure to the patient. There is an old-fashioned remedy...wait for it....UNIONIZE!

This is what many workers used to be able to do to protect themselves when their employers refused to provide a safe and fair workplace.

Anonymous said...

I think docs are completely ignorant about the real world of hospital costs. The NYT article will give you a good idea of what goes on. Since you care, I trust you will read it.

Siso said...

Lisa makes a valid point as does the first Anon that doctors need to work to provide a fair workplace for both employees and their clients.

Keith said...

Amen Wes,

Once we all work for the medical corporation, it will take away all our leverage to act as patient advocates. I have said this for a long time as I have witnessed local hospitals gobble up more physician practices and watched as there is lots of complaining but little action on the part of physicians lest they fall out of favor with those who sign the paychecks. Not a good trend in my mind. It would be better if physicians were separate from hospitals and other health care groups. After all, Medicare does not like it when physicians own their own diagnostic facilities or hospitals, so why should they like it any more when hospitals employ physicians?

Gary Levin said...

Wes: All will not be lost. At the same time a large patient centered movement is growing, which emphasizes openness and transparency for patients and providers alike. Patients are demanding involvement and information. You can have your patients be directly involved by informing them of the barriers physicians have.