All doctors take the Hippocratic oath in medical school to uphold values of providing best medical care and safeguarding the interests of their patients. Though the medical education prepares these doctors to make complex medical decisions and strive to do best for their patients, the path does not teach any economics of healthcare. The result is that all physicians, myself included, come out of our training without having any understanding of the costs of our actions. Our actions at times put our patients in harm’s way by prescribing treatments that either cause undue financial hardship or create barriers that do not allow our patients to realize healing for their conditions.
It is therefore imperative that doctors and healthcare providers in general must understand the inflated costs that our patients have to deal with. All, if not overwhelming majority of doctors want to do what is best...that many times includes coming up with treatment options and therapies that are financially feasible.
Healthcare like any other business is driven by market forces. Since the patient does not directly pay for the service they are receiving, cost/price of care is not considered in most encounters. Since price/cost is not part of the conversation of medical visits, doctors have also become blind to the real and billed costs of things they do. And since health insurers are not present during the appointment, the only way for them to have control is to require ever increasing number of “codes” and longer and longer notes to justify the visit and costs associated with them. Therefore, doctors have become accustomed to do enormous amounts of clerical documentation so that their medical note can be sent to a third party biller who can convert it into computer codes that can then be sent to the insurance company whose computer can parse through this jiberish to generate an EOB (explanation of benefit) with more codes with write-offs and contract pricing, which then end up with patient explaining why despite having paid a premium in the thousands already, and copay at the time of visit, the patient is still responsible for more money in the name of “deductibles.” Due to this “fee for service” model where the physician gets paid more for technical tasks that can be assigned a code, specialists that do “procedures” are invariably paid more for their services. Therefore more and more graduating medical students elect to join specialty fields that are more financially lucrative.
Primary care physicians, the bulwark of good healthcare and guardians of community health only make up 51% of the US practicing physicians...this number needs to be closer to 80-85% to reach effective population wellness as a community. But why would a medical student elect to be a primary care physician and take a pay cut because so much of what they do, counseling, coordination of care, etc. is not even paid properly for their time...so these medical students do what anyone would do, they join specialties which are more lucrative. There is a movement to persuade more medical students to enter primary care but as I stated in my first blog, any program not based on financial feasibility and in-line with human nature is bound to fail...the push into primary care of our graduating medical students will only work when they are paid fairly...an intersection of time, complexity, financial reimbursement amongst others.
So one of several problems with doctors is that there aren’t enough of them who are primary care physicians, and those that are there, have patient panels that are at least 3-4 times what an effective physician should carry; so even if you have a primary care physician they don’t have the time to spend with you to coordinate a proper plan for your health. Then most physicians are completely blinded to the “billed” cost of their services, and “collected” amounts for their services. They also have no transparency of cost of medications and tests that they are prescribing--all of this leads to a fairly complex situation, your medical visit to be even more so, due to lack of information by both the patient and the doctor.
There were 991 million office visits last year and 5 out of 6 Americans had a doctor visit. So it behooves all of us to be effective stewards of our healthcare by being aware of the cost of our actions...patients and doctors especially. This can only be done by being informed and doing research to know your options--internet has put a lot of information on our fingertips, it’s time to start using this to improve our healthcare.
In our next blog we will look at the false sense of security that health insurance creates which feeds into the ever growing cycle of treatment with higher costs.
Dr. Arshad is a practicing physician with extensive administrative experience, who has firsthand knowledge of running a medical practice and working in employed models. WoW Health aligns incentives for the healthcare ecosystem so all stakeholders benefit from transparent and direct relationship between patients and medical service providers.