Consultant Paul Keckley underwent knee surgery in December 2011, experienced significant complications, and a month later published the first of a series of articles on his experience through the health system as a patient.
The executive director at Deloitte Center for Health Solutions saw a $12,000+ bill for just the start of the journey, no emphasis on providers coordinating care and sharing information--even within a facility, slow billings with no attempts to make them remotely understandable and poor patient safety procedures. Here’s an update, presented with permission from Keckley’s weekly Health Care Reform Memo to clients:
“Since my knee surgery on December 20 and subsequent complications, as of this weekend, I have spent slightly more than $3,700 out of pocket for my prescription medications, lab tests, and co-payments to hospitals and physicians. I have not received ‘explanations of benefits’ for two of my five emergency room visits, and for my December 29 eight-hour stay in a ‘Top 100’ hospital emergency room, I have received a satisfaction survey and a receipt for my $100 co-payment--nothing else.
“I can afford my journey through the health system. I am fortunate. Increasingly, many can’t.
“Last fall, the Government Accountability Office examined government and private sector efforts to improve price transparency in health care, concluding it was too confusing to consumers and too complicated for providers. Price transparency is only a modest element in the Affordable Care Act, isolated to one area primarily--requirements that state health insurance exchanges provide consumers information about insurance premiums for qualified health plans they offer. Incentives to encourage consumers to consider prices when non-emergency treatment decisions are made are missing, as are other means of engaging consumers more directly in their care and the cost implications thereof.
“Ideally, an individual should be able to compare prices via a mobile device linked to their medical record and insurance coverage provisions so in that teachable moment, decisions are informed by clinical options and costs… but we’re a long way from the ideal. And in reality, today, the issue is health cost and affordability more than price transparency—though it’s a good place to start.
“I do not agree that prices for routine, uncomplicated tests, procedures, and therapies are too confusing to be useful. In searching a variety of government, hospital, surgeon, and insurance company sites, I can’t find an expected ‘price’ or ‘range’ for my surgery, or even the routine lab tests I am required to do periodically to monitor my warfarin use.
“When I engage a professional to handle my taxes or legal matter, I’m at least aware of an hourly rate and usually a total project estimate as well: not so in health care. It’s hard to know what’s affordable when prices and costs are hidden or inaccessible.
“But price transparency doesn’t solve the issue of affordability and the growing impact of health costs in the average household. It’s more complicated than a shopping list of prices.
“A society reflects its values in services it funds. The arguments for public education, parks, and the arts are parallel to health care, though some in health care might consider its role above others. In fact, our laws separate health care from others, establishing a private system of insurance and delivery that’s augmented by public financing for 110 million people covered by Medicare, Medicaid, military health, Federal Employee Health, and prison health programs. And in fact, our society has reflected its esteem for the health system, having invested 2.6% more than our overall gross domestic product for 30 years in this system of care. But at a cost: affordability for many Americans (directly or through employers) is slipping away.
“To be affordable to the average American and employer seeking to provide health benefits for its workforce, radical cost reduction in the U.S. system is necessary—that’s the bottom line. Our system is expensive: on a unit cost basis, as much as four times what most developed systems of the world pay. And on a volume basis, there’s little in our system to drive demand for acute interventions down in favor of preventive self-care and management of chronic conditions before it’s too late.
“It’s doable, but only if incentives change from fee-for-service to performance, technologies are leveraged to reduce paperwork and error, and price transparency is linked directly to treatment options in teachable moments when decisions can be made.
“It’s not surprising that one in three families is struggling with health costs in some way; it’s not surprising that many resort to delayed care or elect to take their chances in lieu of buying medication or paying insurance premiums. Health care costs are increasing as their incomes have stalled and even those with insurance find co-payments, premiums, and coverage restrictions problematic when gas prices are at $4/gallon and housing values fall below loan obligations. And it’s not surprising that almost half of the U.S. employers, especially smaller employers, have dropped health benefits altogether.
“It’s time for a candid discussion about health costs in the U.S. It’s time to put all the cards on the table to set aside parochial agendas. It need not begin with the presumption that cost reduction equates to poor quality or compromised safety. Rather, it should begin with a white board to re-design the system around a new paradigm, innovative thinking, and bold execution. The status quo is not sustainable.
“For many Americans, time is running out.”
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