Doctors Will Help Change Our Broken Medical System

An Open Letter to My Doctors

Future doctors at Dell Medical School reading An American Sickness in their first book club! via Chris Moriates

You became a physician because you wanted to care for and heal patients, not because you wanted to spend hours a day in billing and administration. I seek medical care because I’m sick, and I don’t want the focus of my worry to be “how much will it cost” or “will my insurer cover this service?” Join me in pushing back against a system that has turned my care, your knowledge and our relationship into a lucrative business. A number of physicians have asked how they can better protect their patients from excessive charges. Here a few ideas/requests:

Join me in pushing back against a system that has turned my care, your knowledge and our relationship into a lucrative business.

Know the charges at the x-ray centers, labs and facilities to which you refer me.

Have your office manager call and demand price lists. Send me to the least expensive ones that do a good job. In New York State, Vitamin D tests can vary between $7 and $700. Send my requisition to the $7 one and tell the one who’s charging $700 that you’ll no longer be sending blood work its way. Likewise, if you perform procedures in a surgery center or hospital, know how much it adds on in facility fees. When Marvina White, of California, was given the choice of having a small cyst removed on Tuesday (in an outpatient office) or Thursday (in the hospital), no one mentioned that choosing Thursday would double the price.

Ask the pharmaceutical reps how much a new drug they’re promoting costs.

When a pharmaceutical salesman comes by your office or hospital to talk up a new drug, ask how much it will cost — the list price. Why does any doctor prescribe Duexis, a prescription drug that merely combines 2 over-the-counter ingredients (Pepcid and Motrin) and yet costs over $1500 a month? Tell all your patients to report back to you immediately if they experience a price hike at the pharmacy. Don’t prescribe drugs that are rip-offs even if you get free samples or there are copay coupons. Once the free samples and coupons disappear (and they will), I’ll be stuck with the bills.

Think twice before selling your practice to the hospital.

You may not be aware, but when hospitals acquire doctors’ practices and take over the billing, they frequently begin charging a hospital “facility fee” or just inflate the charges. That frequently leaves patients on the hook for big bills. When Ellen Debold of New Jersey had a repeat chest x-ray in her longtime doctor’s office, recently purchased by a hospital, her payment jumped from $25 to $500.

Resist the temptation to go concierge or begin charging practice membership fees.

I understand that many doctors opt out of insurance because insurers tend to pay small office-based doctors rock bottom rates, creating an economic situation where you can’t afford to spend time with your patients. But many of us are already paying lots for insurance and can’t afford to pay an extra $1000 or $5000 more — no matter how much we love you. Also if you are not in my network, any tests or referral you recommend may be considered out-of-network too, so I’ll be paying that out-of-pocket too.

Demand to see your hospital’s Chargemaster, the master price list.

Have the medical staff unite to demand such transparency. (One MD asked me: “Any advice for docs on how to get pricing info from employers? They have shared costs of some labs, but then told us we couldn’t share w pts”) Better still, perhaps all doctors in your state can pressure the health department to require such disclosure. That now only happens in California. See if you’re comfortable with the charges being levied on your behalf, for the procedures you do. Do they seem honest or extortionate? Your patients are the ones being taking for a ride.

Ask your medical school or residency program to teach young doctors about costs.

What is the relative charge for an MRI versus an x-ray? How much do those common lab tests cost — the ones that are routinely, unthinkingly ordered on every patient almost every day. Studies show that spending patterns of physicians — are they thrifty or profligate — mirror the habits and mindset of the hospital where they trained.

In the longer term, we must all become Healthcare voters

In the longer term, we must all become Healthcare voters — our votes and our politicians will eventually (hopefully!) force structural remedies to improve our dysfunctional medical system, but in the meantime physicians and patients can partner to push back against profit-taking that doesn’t benefit care.

Thanks as always for caring for me and my family, despite the challenges of medical practice today,

All best, Elisabeth

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