Decisions and Cost
Physicians of all kinds make clinical decisions based on financial realities. Examples include:
• The uninsured patient in need of a gallbladder surgery and is denied by one surgeon because of having no insurance but referred to another.
• Suggesting a cheaper but more invasive surgery to an uninsured patient.
• Closing your office lab because it wasn’t making any money, even though the lab made life a lot easier for patients.
• Or a pediatrician who stops doing vaccinations in the office because payers barely reimburse for the supplies, let alone all the associated administrative work.
• Choosing generic drugs over brand name
• Bartering medical care for services
What are you supposed to do when you’re losing money on procedures and services? Many physicians have to answer this question when they continue to offer labs, vaccinations and other procedures in the office that insurance companies do not reimburse.
Should convenience for the patient be a motivating factor or should you eliminate those services and refer the patient to another facility to have them done?
When the costs are borne by the patient, it should be part of good medical care for the doctor to discuss the financial impact with patients.
If an uninsured patient or one with a high deductible needs a procedure, the physician’s job is to lay out all the options and allow the patient to make the best informed decision. This may sometimes be that patients choose not to proceed with a certain course of action because of financial concerns. Physicians should not make clinical decisions or financial decisions without the patients input and direction.
Many tests and procedures are not emergent and just because patients want them doesn’t mean they are necessary especially if the patient cannot afford them.
I believe it is wrong for a doctor to assume that a patient would want a more expensive or less expensive treatment strictly on the basis of costs. They need information to make these decisions
Physicians have the ability to offer or not offer services based on financial as well as other factors. Patients need to be informed about where they can receive these services, but physicians are not obligated to provide money losing services.
Patients who need procedures and are uninsured may have a ready fund of cash or relatives willing to pitch in. They might be able to make monthly payments. By discussing financial concerns, physicians may help patients find solutions.
As with most businesses, you sometimes take a loss in certain areas to make it up in others. Physicians are no different, but there is a limit on how much you can lose in certain contexts.
I think most physicians believe that refusing to do anything except that for which you are specifically paid is bad business and ethically inappropriate.
Healthcare is getting tougher for everyone and the financial concerns have to play a more important role and be included in the decision making process. Patients are ultimately responsible for their healthcare and need to be the final decision-maker.
• The uninsured patient in need of a gallbladder surgery and is denied by one surgeon because of having no insurance but referred to another.
• Suggesting a cheaper but more invasive surgery to an uninsured patient.
• Closing your office lab because it wasn’t making any money, even though the lab made life a lot easier for patients.
• Or a pediatrician who stops doing vaccinations in the office because payers barely reimburse for the supplies, let alone all the associated administrative work.
• Choosing generic drugs over brand name
• Bartering medical care for services
What are you supposed to do when you’re losing money on procedures and services? Many physicians have to answer this question when they continue to offer labs, vaccinations and other procedures in the office that insurance companies do not reimburse.
Should convenience for the patient be a motivating factor or should you eliminate those services and refer the patient to another facility to have them done?
When the costs are borne by the patient, it should be part of good medical care for the doctor to discuss the financial impact with patients.
If an uninsured patient or one with a high deductible needs a procedure, the physician’s job is to lay out all the options and allow the patient to make the best informed decision. This may sometimes be that patients choose not to proceed with a certain course of action because of financial concerns. Physicians should not make clinical decisions or financial decisions without the patients input and direction.
Many tests and procedures are not emergent and just because patients want them doesn’t mean they are necessary especially if the patient cannot afford them.
I believe it is wrong for a doctor to assume that a patient would want a more expensive or less expensive treatment strictly on the basis of costs. They need information to make these decisions
Physicians have the ability to offer or not offer services based on financial as well as other factors. Patients need to be informed about where they can receive these services, but physicians are not obligated to provide money losing services.
Patients who need procedures and are uninsured may have a ready fund of cash or relatives willing to pitch in. They might be able to make monthly payments. By discussing financial concerns, physicians may help patients find solutions.
As with most businesses, you sometimes take a loss in certain areas to make it up in others. Physicians are no different, but there is a limit on how much you can lose in certain contexts.
I think most physicians believe that refusing to do anything except that for which you are specifically paid is bad business and ethically inappropriate.
Healthcare is getting tougher for everyone and the financial concerns have to play a more important role and be included in the decision making process. Patients are ultimately responsible for their healthcare and need to be the final decision-maker.
Labels: cost, healthcare
posted by Anonymous at 6:20 AM
7 Comments:
I think we need a healthcare system like Canada.
Interesting post, HB. One in which I’ll stick my toes back into the pool to respond.
First of all, to the anonymous poster above, I don’t think we want Canadian healthcare. I think our system of health insurance & physician/hospital reimbursement is definitely a nightmare that needs fixing, but as to the availability of physicians and the resources available, I’ll stay right here for my care. The availability of cheaper non-FDA regulated drugs in Canada, like Zelnorm, which was removed from the shelves here, but is widely available up north, is just one reason. I’ll take financially difficult healthcare over socialized (i.e. slow and bureaucratic) healthcare any day.
As to the issue de jour, I think there is an important distinction to be made. Treating patients WITHOUT health insurance is undoubtedly a costly proposition for physicians & hospitals, one which understandably raises some important issues. I take no umbrage with those sorts of difficult decisions – the practice of medicine, at the end of the day, is a business and a means to an end.
However, to the extent that medical decision making is based in any way, shape or form on the level or amount of insurance reimbursement to the health care provider, then I have a real problem. Ever look at your EOB’s? I truly feel badly for the healthcare providers after seeing the ridiculous write off reductions imposed by the insurance companies before reimbursement even begins. Since when did healthcare insurance companies get to rule the world? I’ve ranted on this blog before about the multi-million dollar bonuses paid to Anthem execs. Look it up – does the $42.5 million dollar bonus Anthem paid to its CEO Larry Glasscock in 2004 not catch the AMA’s eye? Why aren’t physicians up in arms about the ridiculous percentages of the Medicare fee schedule which Anthem, Humana & others ram down their throats each year, while the health insurance earnings escalate? This isn’t an anti-corporate rant, it’s a question that needs to be asked when people start wondering why our nation’s health care system is failing, or why physicians and patients have to start talking about whether INSURED patients can afford necessary procedures. Does Larry Glasscock have to worry about whether his wife or kids can afford necessary treatment based on their own coverage?
Again, I understand the business aspect to running a medical practice. Not explicitly, but somewhat, and I have no faults for having to look at cost saving options, and the viability of certain services. But when patients who are paying out the ever increasing costs of premiums, only to get less in return, and then have to make cost based decisions of significance, there is something wrong. My point is only a suggestion where we might all look first.
I agree,
The AMA should be more up in arms about this issue, but they do not represent our interests as well as we would like.
I very, very rarely ever look at what insurance a patient has when I am in the room seeing them. It is usaually only after they are at the checkout desk or after tests are denied that I am informed about their coverage or lack thereof and at that point, I either discount their bill or discuss alternative treatments and options. This takes more of my time, staff time and patient time to come up with a secondary alternative.
Secondary plans are not always substandard, but at times it can be what I consider less than the best.
We need an overhaul of the system and if limits are in place like the medicare and medicaid fee schedules, than limits need to be in place on CEO salaries etc.
This is price fixing by the government and unfair in its current configuration.
I couldn't agree more with the sentiments of Lawguy. Politically, the majority of our citizens view healthcare as a right, or entitlement. It should be treated as a regulated utility where rates of return are established, and exorbitant profits and salaries are a non issue. It galls me every Sunday to see in the C.J. the insider trading of health insurance executives, liquidating shares recieved as salary or bonus packages.
I have recently read several articles concerning the USA's ranking in the world with healthcare. It is very disturbing. I am not sure that Canada's system is the one that should be copied. France's system was rated number one. That being said, a one payer system is what is needed and serious study should be done to get out of our current insurance company controlled system. There are many scare tactics by those who oppose a one payer system, cost being one of those. If we all took the amount of money currently deducted from our pay and gave this instead to a government controlled system it would be sufficient. Then we could also control some of the need for medicine by changing our ways and becoming more health conscious with nutrition and proper exercise. Healthcare for all, not controlled by annual income, is the moral and correct thing to do for our nation.
Whether you like/dislike, agree/disagree with Michael Moore, after seeing his movie, "Sicko", you have to say there seems to be better healthcare in other parts of the world than here. I think we are often brainwashed into thinking we have the greatest system in the world. Obviously, it's not true.
If we go to a single payer system then dare we call it, "socialized medicine" and Oh, My God!, we won't have any physicians or resources. Our country is being lead by people who spread fear to control the masses and we all are starting to believe it. It's a sad day in America.
michael moore makes cartoons certainly not factual documentaries and anyone who quotes him is ignorant of the facts-a one payer system would cause no one to go into medicine,no impetus for research and if you think its bad now go to canada for your health care--what we need is to get back to the 70"s no managed healthcare.
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