Most people can’t successfully comparison shop for healthcare

by Ateev Mehrotra MD

Comparison Shopping for Healthcare

As a doctor,  I’m the perfect person to price shop for an operation. But the process went terribly.

 

After three months of using hot compresses to shrink the stye on my daughter’s eyelid, it wasn’t getting any smaller. My daughter is prone to this sort of growth, called a chalazion. This one would have to be removed surgically, like the one she had removed from the same eyelid two years earlier.

But there was one key difference this time around: Like tens of millions of people who get health insurance through their employer, my family was now in a high-deductible health plan. That meant we would have to pay for the entire cost of the surgery out of pocket. Suddenly, the cost of the surgery became very important to our family.

Encouraging patients to price shop for their health care is one reason employers are switching to high-deductible plans. The theory is that patients will compare prices across different doctors or hospitals and choose the lower-priced one, thereby saving themselves (and their employer) money. But in order to shop, you need to be able to see what something costs beforehand. Transparency in health care prices is a goal of President Trump’s health agenda, and is a priority for other politicians as well.

My family had every advantage that newly minted price shoppers could possibly have: We live in Massachusetts, one of the states that have passed price transparency laws to help patients shop for care; I am a physician; my research focuses on consumerism and price transparency, giving me plenty of insider information; and the surgery was minor and not urgent, giving us lots of time to shop around.

How did it go? Terribly. Here’s why:

On the website for our health plan, we muddled our way to its hard-to-find price transparency page. When we finally got there, we didn’t get the information we needed: removing a chalazion is not a common procedure, so it wasn’t listed.

An ophthalmologist would remove the growth. The billing department for the ophthalmologist who evaluated my daughter could tell us only what the doctor’s fee for the surgery would be ($1,007) and didn’t know the fees for the anesthesiologist or the operating room, both of which could be as much as, or more than, the doctor’s fee.

To get a better price estimate, we called our health plan. It asked us to submit a written cost request for the surgeon and the hospital we were considering. Twenty-four days later, we received an estimate of $452, which was both incomplete (it only showed the ophthalmologist’s fee) and incorrect (the health plan mistakenly assumed we were in a different insurance plan).

Other ophthalmologists we called said they would give us a price quote for the surgery only if we brought our daughter in to be evaluated. Each evaluation visit would cost more than $200.

One month into our price-shopping effort, all we knew was that the ophthalmologist’s fee would be in the $452 to $1,007 range, and the total surgery would cost much more. All the while, the red, swollen eyelid on our increasingly miserable middle-schooler was waiting to be treated. So, we decided to go ahead and have the original ophthalmologist do the surgery, even though we had no idea what it would really cost.

In the end, it cost us $1,443, including $556 for the ophthalmologist and $887 for the anesthesiologist and hospital. Despite the challenges, we recognize that we were fortunate — our daughter’s surgery went well and we could afford this unbudgeted expense. Others aren’t so fortunate.

Sadly, my family’s price-shopping experience is the norm in the U.S. My colleagues and I have found that most people can’t successfully shop for care, and that offering people a price transparency website doesn’t help them switch to lower-cost providers and doesn’t decrease health care spending.

Why isn’t price transparency currently working? It’s not that Americans don’t agree with the idea of shopping for health care. Most believe it makes sense and could save money for families and the health care system. Many recognize that there’s a great deal of price variation and believe that health care prices have little relation to quality, a suspicion our research backs up.

What can be done? First, we need to bundle payments to hospitals and surgery centers: a single payment that covers everything related to a procedure or doctor visit. Patients shouldn’t have to navigate the craziness of different bills for the hospital, surgeon, operating room, pathologist, anesthesiologist, and the like.

Click here to read the rest of this article originally published in STAT

 

 

 

The joy is being sucked out of the practice of medicine. Here’s why.

Many providers — primary care physicians, physician assistants, and even many beleaguered specialists — are increasingly dissatisfied with their jobs.

What is happening to medical practice and what can we do to bring the joy back to being a health care provider?

She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable for all of her primary care needs. Since she had not received a mammogram that year, or received a diabetes screening, he incurred an end-of-the-year penalty for failing to meet these quality standards.

I am early into a one-year quest to connect with leading thinkers from inside and outside medical care, so I can better understand why many clinicians are miserable in their careers, and much more importantly, what can be done to help them thrive at work even though an increasing number of outside parties are looking over their shoulder, assessing the quality of the care they provide.

These increasingly burdensome rules and regulations are making it hard to enjoy medical practice these days. Several decades ago, physicians largely practiced as autonomous professionals, governed by standards developed by their professional peers. Physicians underwent intense and prolonged training to develop the knowledge and skills to know how best to help patients with their problems. And the world generally stood back and accepted, on faith, that most physicians would provide excellent care to most of their patients.

In recent years, however, outsiders have increasingly tried to assess just how well physicians are performing their jobs. Insurance companies and Medicare administrators are measuring the quality of care physicians provide, and even holding them financially accountable when that care is not up to standards. In part, these external accountability measures have been put into place because people paying for medical care — insurance companies, Medicare administrators, and even patients — realized that the quality of medical care wasn’t always as high as it ought to be. And since the profession wasn’t doing everything it could to promote high quality, they recognized that somebody from the outside needed to hold physicians accountable for their practice. As a result, medical practice has shifted from being autonomous to supervised; physicians have gone from being independent decision-makers to being bureaucrats forced to check boxes.

Click here to read all of this article originally posted on KevinMD.com

Social media return on investment for one practicing physician

by Howard Luks, MD

.

This is a message that should resonate loud and clear with providers, institutions or members of the healthcare enterprise world  who are ruminating over the upsides — and potential downsides — of a wide reaching, multiple digital property social media presence.

As Ted Eytan found out when he questioned the (anonymous) physicians on Sermo, many physicians are simply not interested in establishing an online presence.

“Risk” is the overwhelming variable they’re concerned with.  Yet, I imagine some of these very same physicians are the same ones with static Web type platforms who state that they are the “best,” the “premiere practice,” or utilize state of the art modalities.  There’s probably more risk involved in their promotional language then a venture along well trodden social media circles where we have established and have discussed on multiple occassions what many of the risks entail and how to avoid the landmines that exist .

Many physicians also state that they are not interested in healthcare related social media endeavors because they do not feel that there is a pot of gold at the end of the healthcare-social media rainbow.

If the past two week scales or even maintains, the level of new patients (7-10%) entering my office because of my social media presence and the information presented on my website, then I can emphatically state that the ROI of your time, resources and the presentation of your content in a transparent, meaningful, evidence-based manner will pay off quite well for your practice.  Perhaps even far more important than that (and a more difficult to measure ROI), the patients will be entering your office far better prepared, far better informed, and far more comfortable.   That means they will already have a reasonable understanding of what they might be suffering from, they will be far more comfortable with you because they have seen your videos and are comfortable with your demeanor and presentation.  And in the end, it makes your job in the office far more engaging, more productive and more efficient.

When your blog or website presents meaningful content without the commercialized hype so many marketers are pushing you to use, patients will,

  1. Find you (because of your digital property exposure)
  2. Like you (if they don’t like your videos or content, they’re not coming to your office)
  3. Probably trust you more than a doc they found in the phone book
  4. Interact in the office with you in a far more efficient manner since they already have digested the content you presented to them online — which you can re-visit right then and there to reinforce what you have just told them
  5. Dramatically improve your patient satisfaction scores (data available on request) .

.

My presence online is to support the spread of meaningful, trustworthy, evidence-based, actionable information and guidance to patients and consumers from around the world.  I am personally not looking at my engagement from an ROI perspective. I continue to feel that physicians have a moral obligation to fill Google’s servers with quality content to drown out the commercialized nonsense that exists online today. But for those of you in search of bringing patients in your door, the message here is clear. It works, and it’s happening. With social media, the risk is manageable.

Howard Luks is an orthopedic surgeon who blogs at his self-titled site, Howard J. Luks, MD.