Ran across this blog entitled medical bills suck. Have to say we empathized with their situation. This is a young couple with a new baby and lacking insurance. That’s a tough spot. They are getting hit with medical bills for the birth of their child now, and the mom despairs about not being able to realize the rest of her dreams of owning a home, etc. because of the medical bills that keep holding them back.

But like the comment I posted says, they probably won’t have to pay the whole bill amount. If they just pick up the phone and call and ask for a discount or failing that, ask to make monthly payments, the hospital will probably negotiate. Some rediculous percentage of people (I think around 60% or more. If I find the source, I will come back and add it) who called and asked for a discount got one.

Making that call can be hard for someone with high moral standards and a strong sense of responsibility. After all, if you incurred the bill, you should pay it. The problem is, the docs and hospitals are not burdened by those same standards. Yes, they are healers and are bound by the hypocratic oath, but that oath says nothing about fair payment between patients. It really would not hurt to add something to that end.

Providers (docs and hospitals) generally charge everyone the same for services. However, what they get paid varies drastically between the uninsured and the insured. It also can vary widely between insured. Uninsured usually wind up with the biggest payments made to providers. Then the privately insured. And then the low cost payors – Medicare and Medicaid.

So. All of that to say that chances are she’s looking at paying the equivalent of MSRP (Manufacturer’s Suggested List Price) or the sticker price for the healthcare. Nobody pays MSRP for a car. You should not for medical bills either.

So pick up the phone and negotiate. You’ll be talking to someone in the back office, not the doc. And there’s little need to be worried that the doc won’t take your appoinment next time. Hell, the doc probably won’t even know what you paid.

Even though providers don’t have to charge fairly, if you need them in the future, the hypocratic oath does require them to provide you with care whether you paid the full amount for your previous bill or not.

So it looks like the flu has made it to my house. One of my girls has fever, chills last night, a bit of nausea and headache. Sounds like the flu. I’m starting to feel it, too.

So what’s a good parent to do? Keep the kid home, give her lots of fluids, chicken soup, acetaminophen and/or ibuprofen, and lots of rest. Watch the fever, and if it gets above 102 despite the acetaminophen /ibuprofen cocktail, then call the doc. (for the record, I said call, not frantically make an appointment). That’s what I’m going to do for me. Beats paying a $20 co-pay. Nevermind that the cost of the visit will actually be about $45 from my HSA for her or $65 for me. (Ah, but let’s not head down that rabbit hole in this post.)

So what are we doing? All of the above AND going to the doc. Now here is where I start to sound like an old person. We would never have done that when I was little. Case in point. I’m feeling the same bug, but I’m not going to the doc.

Granted. This is more than the sniffles. She should go. Don’t think me unsympathetic (nor unwilling to spend the few dollars to be sure my child gets well as fast as possible and is not going to keel over from some little-known mutated-super-avian-genetically-modified flu bug). I’m just saying that it’s no wonder our healthcare costs continue to rise. We’re addicted to going to see the doc to get some kind of fix for what ails us.

Maybe we can go see a shrink about it. I think my healthcare will cover it.

Christopher and I are in NY. Met with Steven Krein and Unity Stoakes of Organized Wisdom last night. Great guys – really great. And brilliant. Got a chance to see what they are doing and where they are headed. They are really onto something, and we are excited that we will be working with them on some upcoming projects.

Next step is to get them out of Gotham and down to Music City USA.

Interesting article popped up today on how the healthy population may cost more in terms of healthcare than the obese or smokers. The premise is that the healthy person lives longer and therefore has more opportunity to run up costs in part because they have a longer window to work in.

Let me add a little personal perspective to that. I have been fortunate in my life in that I have lost relatively few people in my immediate family (partially the result of parents who were both late children, and many of my relatives were gone before I was 6). However, lately, the odds have been catching up to me. My parents, my in-laws and many other people close to me are getting older and facing increasingly greater health challenges. One in particular comes to mind.

This friend is a former coach, world champion in sports and just flat out all around great athlete. Never smoked or drank. He is in his 80’s – well into his 80’s. Healthy as a horse. His healthcare costs are piling up – slowly and consistently. Some had written him off at one point. He had a leg amputated due to complications and many saw that as the beginning of the end. For someone less healthy, it probably was. That was nearly two years ago. But well into his 80’s, he is going strong. I actually carried his mother’s casket at her funeral when she was well into her 90’s. I suspect that he will live to a similar age. Ironically, I wrote a piece on him in grade school about how I admired him, and here I find myself over 30 years later writing about him again.

Another friend is much the same way. Never smoked, never drank. Kept her figure. She has had a number of near misses lately. Much to our pleasant surprise, she continues to move forward and recover. A less healthy person would not fare so well. I interviewed her for a high school history project where we taped the conversation to capture some of the pieces of history locked inside of the average person and that might otherwise be lost. She continues to this day to be a wonderful source of history.

 I can point to many others I have known – less healthy, far younger and far shorter illnesses took them. It’s all anecdotal, but it’s hard to ignore. I think this underscores the mission of what we are doing at change:healthcare. It’s easy to think that it’s only the less-than-healthy who need to keep up with their healthcare and the associated costs. But it’s not. It’s all of us.

So how do people choose a healthcare provider? We jokingly refer to it as the three C’s – Cost, Conversation and Quality. The truth is there are a lot of factors that go into a healthcare decision, but quality would seem to be what trumps all. But how is quality defined?

There is a lot of talk around quality. It’s another of the industry buzz words like transparency. And like transparency, quality can be entirely subjective. Ask the question, what is quality, and ultimately the answer emerges “I know it when I see it.”

But what are the elements of quality? We speak with people at different levels of income and various walks of life about quality in healthcare all of the time. Our conversations are informal, but interesting. Here is some of what we hear.

Outcomes

Generally the first response we get when we ask some to define quality is “It’s all about outcomes.” – the results. How quickly a doctor’s patient recovers or even how long they survive. There is a significant amount of data out there on outcomes, but if people are honest with themselves and really dive down into how they’ve selected a provider, they realize that outcomes received 3rd, 4th or even less priority in your choice if it ever was given consideration at all. Often times, it is simply assumed based on a provider’s reputation.

Outcomes data is publicly available. Morbidity rate or the number of deaths per hundred or thousand with a certain diagnosis can be a quantifiable metric. So which outcomes data is it? Just be sure to take into account that an oncologist specializing in stage 4 patients is understandably likely to have a higher morbidity rate than an oncologist who sees patients in all stages.

Experience

This is another metric that is available, but open to interpretation. Do you base experience on how many years a doctor has been practicing? Or how many times has a provider performed a certain procedure?

Convenience

In our drive-thru, 24-hour, print on demand society, convenience is a major deciding factor. If you’ve ever been to a retail based clinic, you know just what we mean. It’s a heck of a lot shorter wait than the ER or even your doctor’s office. You might really like your doc, but if you’re sick, who wants to wait until this afternoon or tomorrow?

Where do you get your prescription? Those large chains with a location on virtually every corner are pretty darn convenient. But do they fill the order right the highest percentage of the time? What about the cost tradeoff? Our research shows that those that are most convenient are often the most expensive.

Having sharp chest pains? I bet you didn’t drive anywhere other than the closest emergency room. Do they perform the most open heart surgeries? Are they more likely to try a less invasive solution like a stent before cracking open your chest?

Location

The three most important things in real estate are location, location and location. So how far did you travel for your doc? Did you do a national search to find the best specialists? Did you look internationally? If you live in a small community, you may be fortunate and have a really good set of options for healthcare. But it’s doubtful that you have the top specialists for your specific need. Chances are you’d have to head to a larger city with one or more hospital systems to get the better specialists – though there are exceptions. I know of one instance where a top NY specialist decided he wanted the simpler life and moved to rural

Referral

If real estate is location, location and location, then for providers, it’s referral, referral and referral. Most people go to the provider their physician refers them to. Your physician will direct you to other doctors within their medical system – probably other physicians associated with the hospital(s) where they have privileges.

Many of the large hospital systems have an ongoing practice of purchasing outside clinics. While those are viable businesses and they can justify their purchase through the revenue earned, there is a more important aspect – the referral. Hospitals depend on the front line physicians to make referrals for the higher dollar procedures that their patients will require. There is little better way to ensure that they get those referrals than to tie them into the hospital’s system.

Now don’t get me wrong, federal law prevents doctors from referring patients into businesses from which they profit. But once the doc is in the hospital’s system, the hospital has numerous ways to encourage using their providers. They may offer administrative and billing services, a common appointment setting system, have ongoing internal communications that let their providers know what other providers are available and many other incentives. That may all sound trivial, but doctors are busy people, and just like convenience is a factor for you, so it is for them.

Bedside Manner

How you get along with a physician heavily influences your choice of a provider. It can be the deciding factor in vetoing a doc. Numerous people we talked with have selected a doc because they have a great reputation, have been referred into them and have all the right experience and credentials. And then, they have rejected that provider because of bedside manner. I am guilty of vetoing a provider for my own needs over bedside manner. He scooted in and out and did not give me sufficient time to answer questions and assess my situation. He is head of surgery for a department in a large hospital specializing in that particular field and came recommended by my physician whom I trust.

Cost

Even among the well-to-do and very well insured, we heard, “Cost is not an issue.” But don’t be fooled by that cavalier attitude. Sure in situations of life and death, no one asks about the costs. But when it’s not, it is all about the dollar spent. Even if you don’t think so, your insurer probably does, and your provider is trying to watch that dollar as well. Providers will often try the least invasive and least costly procedures first before moving into the more expensive procedures and/or referring you on to a specialist. It may be in part because that’s what the insurer will allow, and it may be an effort by your provider to watch what they know you are not. So even if cost is not an issue, be aware that it is distinctly a factor in your care and may be part of what determines when and to which provider you ultimately get referred.

Cost can be a major consideration for uninsured, underinsured, treatment outside of coverage or whatever the reason. The rates providers billed, get reimbursed, their insurance paid and their patients paid are all readily available. Just check out the Compare tab in the change:healthcare website.

And if you think that costs are not an issue, consider how providers handle their billing – what they get pre-authorized, what is covered or not could determine what part of the bill you get stuck with at the end of the day. Providers who are on top of their billing may do a good job of making sure they get the insurer to pay most of the bill and minimize the cost to their patients. If they are not, you may wind up with more of the bill than you would have with another provider who did a better job. So it’s important to see how your provider fares in what the patient is left paying versus other providers of the same services and procedures.

Network

Your insurance network plays a strong role. This is a factor that ties closely into the issue of cost since going out of network generally implies a higher cost for a provider. However, if youve ever gone through a list of doctors within different plans to find out if your doctors are listed there, your network is influencing which docs you will see. Any future selections are then constrained to those providers in network since they are often inclined to refer to other providers who are in the same network.

Your insurer will provide you with a directory of providers who are in-network. What about those who are not? You’ll have to go someplace else for that list.

The Water Cooler and Over the Fence

Choosing your healthcare provider is arguably the most important decision you will make in your life. It can literally be a life and death type of decision. And what ultimately decides where you go comes down to that conversation that you have over the back fence with your neighbor or friend or the water cooler conversation with a co-worker (who, by the way, shares the same network you do through your common employer).

If your source is a qualified medical professional, their opinion carries great weight. But if it’s not, it’s really more of an assessment of that person’s personal experience. They are reacting to their personal outcome, the convenience of the doctor, the proximity to them, the referral they got from another physician, the amount their insurer left them to foot, the doctor’s bedside manner, their compatibility with that physician’s personality, or the conversation that they had with someone last week over the fence or at the water cooler.

What’s a Responsible Healthcare Consumer To Do?

Do your research. Seek out the quantifiable data and select a few providers. Call around. Ask about them. Google them. See what other people are saying about them. And when all else fails, go see them. Have an office visit. See what you think. After all, it’s your health we’re talking about here, not that annoying guy in accounting.

What did I miss? Any other suggestions? We would love to hear them.

No matter your candidate or your party, let them know you’re passionate about reforming healthcare!

The new change:healthcare bumper stickers are in!

Shoot me an e-mail at rhendrick [@ symbol] changehealthcare [dot] com with you mailing address, and we will get one to you in time for the remainder of the primaries (unless of course, they move them up some more – there is talk here of moving ours to last week).

Figuring out your credit card bill is tough, but you do it because it has implications for your credit score.

Figuring out what you owe the doctor is just as tough if not more so and often time far more expensive than that monthly credit card statement. At least you know what you bought with your credit card. A billing statement from the doctor or hospital leaves you scratching your head at the archaic abbreviations they use to describe whatever it is that they did to you.

And now along comes your MedFICO score from Healthcare Analytics like a consumer’s credit rating!

What’s a responsible healthcare consumer to do?

How can you keep track of your medical bills and avoid winding up with a bad score? That poor score may not keep you from receiving care as some fear, but it may wind up costing you more and sooner. Before you check out, the hospital may ask you to pay or if you can’t right then and there, they may ask you to sign a promissory note. Think they won’t do it? Some already do (see page 2, second paragraph). And guess what? The hospital has no idea what discount you might get by virtue of your insurance company’s negotiated rate – not until they “run it through” your insurance – and I know of no insurance company offering real-time adjudication (the insurance industry technical term for “running it though”) at this point, though many aspire to it. So could you be overpaying? Sure.
Consumers need products like MedBillManager and Intuit Health (though I have a decidedly prejudiced preference for the former). Patients and their caregivers need the services of medical bill review companies and audit services that identify innacuracies in billing. Healthcare long ago threw off its charitable aura and has become a business. It’s time for consumers to realize that and act accordingly. It’s time for consumers to take responsibility for understanding their healthcare and making the decisions and stop allowing the healthcare industry to hide behind the excuse that healthcare is too complex for the average consumer to understand. It’s time for comparing the pricing of a strep throat test to be as simple as comparing the price of an oil change.

The business people behind healthcare are getting serious about becoming a real business. It’s time for Americans to get serious about being real healthcare consumers.

Not convinced? Then check out some of these articles:

http://www.dallasnews.com/sharedcontent/dws/bus/stories/121207dnbushealthcredit.299ccc0.html
http://www.vimo.com/blogs/consumer/?p=142
http://bestamericanhospital.blogspot.com/2008/01/health-industry-develops-medical-credit.html
http://susiemadrak.com/2008/01/18/21/22/medical-credit-reports-in-the-making/
http://forums.vwvortex.com/zerothread?id=3640720
http://www.sltrib.com/business/ci_8015982
http://www.just-a-webpage.com/rantings/?p=372
http://www.thepittsburghchannel.com/news/15131060/detail.html
http://forums.catholic.com/showthread.php?t=214154

This is a sure sign of the pending Apocalypse – medical gift cards. I had to go back and make sure it was not The Onion.

http://wcbstv.com/seenon/medical.gift.card.2.613799.html

I stand accused of being a cynic about the healthcare system in this country. But I offer this article in my defense.

May I plea bargain to being a realist?

I’ve had enough. I’m leaving this country. (But only for a short period. I’ll be back.)

Got a chance this week to spend some time with a wonderful person, Susan Wentz, MD MS, at Case Western Reserve University in Cleveland, Ohio. She’s a very insightful person when it comes to many things, especially healthcare. I mention her because she gets credit for this initial analogy. I just took it a bit further and blogged it.

Susan and I had made arrangements to meet at her office. Her colleague, Catherine, gave us directions on how to get there. Two paragraphs of directions she gave us. And not concise paragraphs. Katrina and I found it a bit amusing at first, until we arrived on campus. We needed every word of the two paragraphs which basically ended up depositing us at the door marked Visitors Entrance. From there, we were to call, and Susan would come get us. Thank goodness she did!

If you’ve ever been on a hospital campus, you know the frustration of trying to find your way around. You can literally be on one floor of the building and not be able to get to another area on the same floor without going back down to the lobby, changing elevator banks, asking directions from the desk once more to be sure you have not lost you mind, riding up a different elevator bank, and latching onto a poor sole who takes pity upon you when they see that lost look on your face.

You know the medical campus. It started out as a couple of buildings. Over time, another one got built in between. And then they joined two of the buildings by putting another building in between. They tore down a bit of another, but that was so they could join up the one that hadn’t been assimilated just yet. And then they acquired that old grocery store property that had been on the corner and built another facility. Ooh, wouldn’t a skybridge be cool – like a tentacle stretching across the street! The elevation is a bit different between floors, but it’ll be OK if the bridge goes from the 3rd floor on one side to the 4th floor on the other.  This skybridge thing is IT! Let’s do more – like an octopus! And now you can’t get to the clinic the same way you got there the last time. Sure the facades of the original buildings still peek out in spots, but this is no longer the hospital you knew. I mean, how many helipads do they really need? You have to wonder why they don’t just tear the whole damned thing down and start over clean.

Maybe that’s what they should do.

And that’s what our healthcare insurance system has become – a giant, bloated, overbearing, seething mass of non-matching additions, expansions and non-compatible renovations. Navigating the healthcare system has become as difficult as navigating the hospital hallways. There are dead ends. Delays. Confusion. Frustration. There are exorbitant costs. Huge expenses that no one seems overly concerned about trying to control. There’s no one there to help guide you. You literally wind up looking for someone who seems to have the same ailment as you and see if they’ve figured out how to navigate things so that they can help you. The healthcare system and the healthcare facility have developed in an ironically parallel fashion. You have to wonder why they don’t just tear the whole damned thing down and start over clean.

Maybe that’s what they should do.

By way of explanation, the $4 prescription is a misnomer. Some are $4. But for the most part, what the pharmacy is doing is simply reducing your co-pay to $4. They still charge your insurance for the part above your co-pay, be it Medicare, Medicaid, or private insurance. You’re still paying for the balance of the prescription, just in the form of premium paid in to your insurance that is used to reimburse the pharmacy.

So kudos to Matt who pointed out the following:

“If your copay for generics is $10…what with all the offers at Wal-Mart, etc. it seems it may almost be smarter to just act like you don’t have insurance when you go to get your generics filled and pay the $4.  It saves you a few bucks, and I would imagine reduces your insurance’s view of you as a “high-end” user.”

True. And that might work for a period of time, but eventually you will probably hit a snag. And here’s how.

Whenever you take your prescription in, the pharmacy asks Have you ever filled a prescription here before? That way they don’t have to re-enter the records. So the first time you go, you say, No I have no insurance. So far so good.

The next time, your prescription(s) may not be on the list of $4 drugs. And now it REALLY costs something. Oops, well maybe I do have insurance. Here it is.

Next time you go in, they’ll ask you if you’ve ever filled a prescription there before. Nope, you say. Hmmm. We have that name at this address. Is that you? Oh, yes. Is this still your insurance? Um, no. I mean, well, yes. Um, is that on the $4 generics list?

And even if you tell them that the insurance is no longer valid, there’s a decent chance they won’t even ask and may just run it through on whatever insurance they have on record.

“Oh what a tangled web we weave, when at first we practice to deceive.” – William Shakespeare