First, Do No (Financial) Harm
How a Five-Minute Conversation with a DPC Doctor Can Save You $5000
[Note: Any information that would appear to identify a patient has been altered to protect patient privacy].
I had a patient a few months back who needed an MRI. She had seen a specialist who evaluated her and gave her an order slip for some lab tests and imaging studies.
When I called the patient after the appointment, she was concerned about how much everything would cost.
In the conventional healthcare system, this conversation ends with, “I don’t know, let’s just see what your insurance will cover, (and hope for the best).” Doctors typically don’t even have the time to help patients figure these things out.
Instead, I opened my laptop, pulled up my pricing database, and searched all of the imaging centers in a 50-mile radius. I knew the patient’s high-deductible insurance this early in the year meant everything would be coming out of pocket for her if we didn’t find another option.
“Huh, looks like the MRI that got ordered at [the big hospital in town] would have cost you $6000. I can get you one for $700.”
How is that kind of price discrepancy even possible? And what in the world is a pricing database?
When we started this mom-and-pop-style practice, we knew that we couldn’t do everything in house. A cardiologist needs to read that echocardiogram of your heart, and, like nearly every Family Medicine practice, we don’t have an in-house radiologist or an MRI suite.
But we do have a cell phone; early on, we made a list of all the imaging tests we could think of, and then called up every imaging center within a 50-mile radius, and asked for their cash prices for these tests.
We then compiled a searchable database of all the imaging quotes we found, which we can then sort and filter by price and location. If I wanted to know where to get the cheapest CT of the abdomen, for example, but not from hospital X or outside of city Y, I simply search for the test and then select the criteria I prefer.
Need an ultrasound within 10 miles? We can give you a price in less than ten seconds. Or, if you don’t mind traveling another 30 minutes, we can show you something that costs $100 less. Voila.
That one, five-minute conversation saved my patient $5300. We all know that a five-grand difference can go a long way: a vacation, a car, the bills, your child’s education, food on the table, or perhaps covering medical bills you’re still paying for from years ago. (What would you do with an extra $5300?)
You would think that these large price discrepancies would be common knowledge among doctors. But here’s the twist: despite ordering all the tests, by no fault of their own, most doctors outside of Direct Primary Care don’t even know how much the tests they order cost.
In medical school, we learn the guiding principle of our profession: first, do no harm. We understand that it’s our job to protect the patient from any number of potential dangers.
But the unexplored facet of this saying is that we’re not just talking about physical harm. There is financial harm that comes with exposure to the healthcare system.
The entire industry, unfortunately, is designed to extract as much money from patients as possible, and they’re able to do this because patients can’t easily find the information that would help them make an informed decision. Patients can’t get timely and accurate quotes, and only see the bill after they’ve received the care. If they feel like the price is too steep, they can’t easily talk it over with a doctor who can compare pricing for them and help them choose between better options.
As a result, facing insurmountable barriers, the patient ends up just getting the expensive test. Insurance companies then see the inflated healthcare charges, and hike up the premiums you pay for the next year. With every exposure to the System, the cycle repeats, and healthcare continues to become less affordable for patients.
To make matters worse, doctors may learn what the best tests are, but cost is rarely a factor in what makes for the “best” test in formal training. Because every patient has a different insurance plan, doctors can’t accurately predict how much someone will have to pay, even for the cheapest tests. Self-pay pricing isn’t something most doctors have memorized, or even have access to if they wanted it.
But once doctors are in a position to learn how much things cost, they can exponentially increase the value they provide as stewards of a patient’s health.
Direct Primary Care is based on the concept that the doctor-patient relationship is valuable, and one of the ways we can demonstrate that value is by saving patients as much money as possible as they encounter the healthcare system. It’s our obligation to protect the patient and minimize that financial risk as much as possible.
Healthcare, as a whole, is unequivocally sick. For years, patients have been on their own, trying to navigate a system that has been created to obfuscate costs and serve the interest of parties who place their own margins above the patient’s needs. It’s telling that patients would even need a guide to help them through such an inhospitable environment.
The good news, though, is that it’s getting better. Direct Primary Care is a chance to serve patients in ways that were unimaginable 20 years ago. Doctors in DPC practices across the country are working to make it easier for patients to have access to the information they need, so that they can make the best possible choices for their own care.
We’re arming ourselves with the right information, so we can make that $5300 difference in as many lives as possible.
