2014 March 26 The Siuslaw News.com
Price Transparency in Health Care
A patient asks their doctor, “What's it going to cost?” The doctor is likely to be stumped. Ask a dentist, a mechanic, or a travel agent before buying? No problem. But health-care costs are kept hidden from the physician---who should be guiding patients through a maze of potentially bankrupting expenses.
There are some resources available for drug prices on the web, but our clinic uses a web-filtering service that blocks those sites from the doctor's view. Years ago, at a metropolitan clinic and hospital, I offered to write software that computed prices of prescriptions, but the administration told me they would never install nor allow physicians to use such software.
Apart from drug prices, most patients don't realize that some imaging tests and procedures done nearby, along the I-5 corridor, may cost 1/10th the price. In 2012, Massachusetts enacted a law that requires clinics and hospitals to provide advance price quotes within 2 days of a request.
So, ask your local hospital executive: Should doctors and patients be allowed to know the costs up front? Is someone else better positioned to regulate costs assigned to the patient?
2014 March 19 The Siuslaw News.com
Talk to My Call Center
Is the quality of medical service something a community can defend?
When you donate money to your local hospital or clinic, understand that your next phone call to schedule an appointment may be to a distant call center.
And, if you can get through to a person, that person will not know you, or Florence, or current disruptions on campus, or walk-in clinic wait times, or your doctor's up-to-the-minute schedule openings. They won't have a prioritized list of patients to call if a slot opens up. They won't be available to schedule follow-up appointments, while the regular assistant is rooming another patient. Team coordination between doctor and scheduler will be lacking. In sum, quality will suffer.
But as a patient of mine put it, “It's a business decision.”
What's missing from that viewpoint is the understanding that the local clinic and hospital can be the only provider for a service that many cannot live without. Thus, the community suffers from a cheapest-solution business mentality. Similar changes may be occurring at clinics across the country, but is that the manner of service we want to support?
2014 March 5 The Siuslaw News.com
On Deductibles and Expendables
If the Sisters of St Joseph of Peace were distributing health care in Florence, would they serve the wealthy and platinum card holders first?
High deductible health plans (HDHPs) often present an imposing hurdle at the start of the year to those who can least afford it. In contrast, those who don't sweat a thousand-dollar check may go to the front of the line, early in the year, and still like their low-cost insurance.
In this town, wealthy and poor and just-getting-by sit in the same clinic waiting room. But the financial bite is much more painful for that third group with high-deductible insurance. So, they will often neglect or postpone symptoms, tests, and even treatments due to out-of-pocket costs.
I recognize the motive to reduce any cost-unconscious entitlement mentality, but the standard micro-economic principles for consumer behavior don't apply to health care. Precious few enjoy excessive testing and treatment.
Some workers and employers may insist HDHPs are the only plans they can afford, but the plans are regressive, costing the fortunate less than the unfortunate.
Would the Sisters want a system that so rewards wealth and where sick workers are told to go home until they've saved $6000 or more for their out-of-pocket limit?
Is that the best we can do for our neighbors and descendants?