Health care system needs triage

Cady McGovern, The Daily Record Newswire

I’ve spent my entire life peripherally involved in the medical industry. My paternal grandfather was — and my father is — an orthopedic surgeon. My sister is in nursing school, and my sister-in-law is in medical school. I worked as a medical biller for about a year.

When it comes to the U.S. health care system, I’ve participated in many a Thanksgiving-dinner debate and experienced firsthand the frustration of navigating the health insurance industry. Over the years, my distinct impression is that the industry has no shortage of problems, and a massive dearth of solutions. And while it was nice to see the government doing something about it with the Patient Protection and Affordable Care Act, I think that legislation barely scratches the surface of our health care system’s problems.

I don’t think there’s any one solution for our nation’s health care woes, but I do think there are things we could do to ease the pain of both patients and practitioners.

Make patients aware of costs upfront

Would you order a bottle of wine without knowing the price? Would you buy a car without that information? What about a house? Patients are asked every day to pay for expensive procedures, supplies and medications without being told upfront how much it will cost. It’s incredibly frustrating, and it stifles the free market principal of being able to shop around for the best price.

Believe it or not, the same procedure can cost drastically different amounts at different facilities. But clinics and hospitals don’t list their prices. Patients can’t compare prices beforehand and ask why the cost is higher at one hospital than the other. Even an estimate would help put patients’ minds at ease: The cost for your knee arthroscopy will be $2,500 with no complications, but could be up to $5,000 if we run into something unexpected.

It’s hard to imagine comparing prices while in pain, but the cost of care really does matter. And even if knowing the cost of a procedure doesn’t help a patient save money, at least he knows what to expect and whether a procedure is going to mean a serious change in the way he manages his finances.

In addition, not every physician will agree on the same strategy of care. Health care is not a hard science. If one doctor recommends an expensive procedure, another may want to try nonsurgical options. Sometimes a patient can wait to see if the body will heal. While not every patient has a range of treatment options, some do.

When I worked as a medical biller, it was the company’s policy to calculate how much patients would likely have to pay for their services and provide an estimate. It wasn’t a perfect policy; patients would sometimes be upset if they had to pay more than they were quoted, even though we made it clear the quote was an estimate, not a guarantee. But the policy did allow people who thought the cost was too high to discuss with their doctor whether our services were truly necessary, whether there were alternatives or whether they could wait until their financial situation improved.

Make costs transparent
Insurance allowables — the amount that can be billed for a service — don’t always reflect the actual costs of care, and most medical costs are based on insurance allowables. Some insurance allowables are less than the break-even cost of a procedure or supply. And sometimes it’s hard to figure out what allowables are actually based on.

There also seems to be a misconception about who is being paid for services. When the hospital bills $30,000 for a joint replacement, that money isn’t going straight into the physician’s pocket. It has to cover the cost of the equipment used, the nurses and anesthesiologist who were involved, the expense of prepping and sanitizing the room and surgical implements, and the wages of the hospital’s support staff, among other expenses.

Stop subsidizing unhealthy foods

According to the CDC, 35.7 percent of U.S. adults are obese. Obesity can lead to heart disease, stroke, type 2 diabetes and certain cancers. Medical costs associated with obesity were estimated at $147 billion in 2008. In 2011, no state had obesity rates less than 20 percent.

Government subsidies for crops like corn help make unhealthy foods inexpensive and ubiquitous. For example, high fructose corn syrup may not be any unhealthier than cane sugar, but because corn is subsidized, high fructose corn syrup is cheaper than cane sugar. According to Scientific American, “Between 1985 and 2010 the price of beverages sweetened with high-fructose corn syrup dropped 24 percent, and by 2006 American children consumed an extra 130 calories a day from these beverages. Over the same period the price of fresh fruits and vegetables rose 39 percent.”

The government does not need to eliminate farm subsidies, but it should shift its subsidy model from a commodity-based system to a public health-based system.

Obviously, there are many factors contributing to obesity in the United States, but it does not make sense to use taxpayer dollars to make unhealthy foods inexpensive, and then use taxpayer dollars (via
Medicare and Medicaid) to treat obesity-related illnesses among people who can’t afford healthy food.

Coordinate care

I know this is part of PPACA, but we don’t need to wait until all the bumps of electronic medical records are smoothed out before making more efforts to coordinate patient care.

As insurance requirements change, providers need to keep in touch with their referral sources about the kinds of documentation the referring doctor has to have on file to ensure payment. Patients should inform each physician they visit if they also visit other specialists, and request that those doctors share each other’s records via fax or secure email.

Communication between doctors’ offices to coordinate patient care adds some time to the process, but the benefits of having a full picture of the patient’s health are worth it. It also saves time in the billing process if providers have a comprehensive record of a patient’s treatment.

Listen to your doctor

This one is entirely up to patients, but it may be the most essential step in fixing our health care system.

Patients need to listen to their physicians. Too many Americans sacrifice their own health because it feels good to smoke, to drink too much, or to eat sweets and greasy food (I’ll be the first to admit I’m guilty of overindulgence). Too many Americans don’t exercise because Game of Thrones is on and then there’s this really great article on the Internet and look, now it’s time for bed (again, guilty). Too many Americans don’t take their full course of antibiotics or give their bodies sufficient time to heal from injuries.

Listening to physicians’ advice is something every patient can do without adding to their healthcare expenses. And if truly following your doctor’s advice doesn’t improve your health, seek a second opinion.

The bottom line
The U.S. healthcare system is broken in so many ways, it will probably take many years and even more compromises to hammer out a reasonable fix.

We must first find a way to keep America healthy, and then find a way to fund it. Otherwise, the system stays on life support for the forseeable future.


Cady McGovern is Focus editor for the Idaho Business Review.