Paul Keckley, executive director at the Deloitte Center for Health Solutions, recently underwent knee surgery and things have not gone so well on the treatment and payment sides.
He’s been reminded that there’s nothing like using the health care system to see its strengths and weaknesses. In Deloitte’s latest weekly “Health Care Reform Memo,” Keckley lays out his experiences over the first month following surgery and promises follow-ups, which Health Data Management also will publish:
It’s been 34 days since my knee surgery and subsequent clotting complication. I’ve used two hospitals in two states, three labs to draw blood to monitor my coagulation, and countless hours online trying to figure out my propensity for further complications that might lie ahead.
To date, I have received bills totaling $12,712 from the surgeons, anesthesiologists, and hospital #1 for the initial procedure December 20; none from the series of events that started December 29, when I collapsed. And in the process, I’ve incurred out-of-pocket costs to date of $1,502, with more to come I’m sure.
There’s nothing like using “the system” to see its notable achievements and unfortunate shortcomings. My circumstance is relatively minor compared to others facing vexing health problems or caring for others. I am lucky to be able to afford my health care and fortunate to have relatively good health. So each of us starts from a different place, deeply personal, in assessing the system of care. My current medical journey reminds me that we are far from operating a system of care. I wonder:
* My medical records should have been shared between the hospital #1 and hospital #2 and by the care teams. They weren’t.
* My Warfarin directive from hospital #2 should have been informed by a thorough understanding of my medical history and query about my use of over-the counter remedies, nutrients, and vitamins. It wasn’t.
* My care teams should have been consistent in their directives: the PharmD and emergency room docs offered strikingly different assessments, and the hand-off by attending nurses was handled poorly in my eight hour extended stay in the hospital #2’s emergency room.
And the costs associated with my care in all these settings should be more understandable. They’re not. The endless flow of statements, bills, and explanation of benefits (EOB) I am now receiving is confusing, and it appears they will dribble in over the next month or longer. I ponder:
* Why is it virtually impossible to understand an “explanation of benefit”, especially when the math doesn’t compute?
* Why are my out-of-pocket costs for medications more than my out-of-pocket for hospitals and physicians?
* Why was a relatively minor surgical procedure so expensive? It took only minutes.
* And why, 34 days after the events unfolded, am I lacking some bills from hospital #1 and am in receipt of none from hospital #2? I know 99 percent of claims to third parties are filed electronically within days. Why is the consumer last to know?
This week, a bipartisan joint conference committee in Congress will take up extension of the payroll tax in tandem with a fix for physician payments (Sustainable Growth Rate [SGR]) and extension of unemployment benefits. And the bigger discussion in DC for weeks to come will be about deficit reduction, economic recovery, and government spending.
It seems clear that health costs contribute to the fiscal problem facing the U.S. For the past three decades, health costs have increased at 2.1 percent above the average annual GDP. In 2010, inflation increased. Combining Medicare, the federal portion spent for Medicaid, military health, and coverage for federal employees, health spending at the federal level is almost 25 percent of all spending. According to the U.S. Bureau of Labor Statistics’ Consumer Price Index, released last week, hospital prices increased 5.8 percent in 2011 vs. a 7.6 percent increase in 2010; physician increases were 2.7 percent after increasing 3.4percent the prior year. In the same period, the overall inflation rate increased 3.16 percent in 2011 vs. 1.64 percent in 2010, and the consumer price index increased 3.0 percent in 2011 vs. 1.5 percent in 2010.
Most people like me simply meander through stacks of bills, statements, and EOBs and then give up. I am fortunate to be among the 84 percent with some form of insurance coverage, and I have studied the system for 40 years. But my medical excursion these days reminds me how far we are from a “system” where appropriate evidence-based care is readily accessible and verifiable, redundant paperwork aggressively reduced, costs and their relationship to prices is easily obtained and comprehendible, and essential medical information is shared among providers to optimize care and avoid error.
“Systemness” is achievable but lacking. Amazing we can put humans on the moon, but we can’t explain medical costs or share medical information effectively in an industry that represents 18 percent of our overall GDP employing 16 million and consuming 19.8 percent of U.S. household discretionary spending.
We have a long way to go to improve the U.S. system. And cost reduction seems to be an obvious priority if it is to be accessible to our children and grandchildren.
I am keeping a diary about my experience: one set of notes about the quality of medical care and the other about costs. Hopefully, weeks from now, I can close the chapter on the experience, and my data will show a clear relationship between costs and value. Stay tuned.
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