Stanley Feld M.D., FACP, MACE
Physicians have the same problems. Dr David Westbrock’s knee story is chilling. Recently I received an email from a Clinical Oncologist. From the physicians point of view treating patients with chemotherapy in the office is more efficient and cheaper than sending them to the hospital for treatment. It provides one stop shopping for the convenience of the patient and generates Centers of Excellence in physician’s offices. It also promotes the physician-patient relationship.
The government is worried that physicians are going to cheat their patients by over ordering tests. Laws been written to “protect patients from their physicians.” The government laws figure that all physicians are crooks and will take advantage of their patients. Who is going to protect the patients from the hospital? The hospital charges for chemotherapy are three times the charges for the same treatment in the physician office. However, both fees are opaque. The physician fees are a little less opaque than the hospital fees. Many times the add on complications and procedures raise the price further in the hospital. Patients make little personal contact with anyone in the hospital. When the patient gets the very expensive bill who does he get angry at? The person he had contact with. His physician. This does not help the patient-physician relationship at all. I think about 50% of the therapeutic effect of treatment is the patient-physician relationship a relationship that is eroding at a rapid velocity because of the conditions of practice. Patients want to know why we are recommending a certain therapy. Instead today the patient get a call from the physicians nurse being told that the doctor wants you on this medicine and she will call in a prescription. The patient-physician relationship is not a commodity!
The following is John’s (the Clinical Oncologist) letter to me.
The two tier reimbursement system visa a vie community services and hospital services is enormously pervasive and threatens all community outpatient delivery. As an example, hospitals are paid and charge several times the fee that community oncologists are paid and charge for cancer chemotherapy drugs. All the drugs purchased by the hospitals and community physicians cost essentially the same dollar amount. Most hospitals get the benefit of somewhat lower drug prices. Have you ever seen a hospital charge sheet for cancer drugs? The patients treated have. It’s mind boggling. This healthcare policy is forcing community oncologists to send patients to hospital outpatient departments. In this very personal physician-patient relationship, this healthcare policy is destroying the physician-patient relationship that is critical to the care of the patient, with cancer.
Getting a hospital charge and Medicare reimbursement is a totally different thing. Seen inconsistently and usually when the patient wants to question this or that about a hospital stay. This, of course, is one of the issues. Very opaque. A patient cannot go to a hospital and ask the charge for 75 mg Taxotere. What Medicare or some commercial insurer will pay is also not available to the patient because what they charge and what is paid is totally disconnected. The patient can ask my office and I will tell them all the prices.”
As physicians we have the same problem patients have. The hospitals and insurance industry want to keep us blind to their charges and payments. In studying DRGs, I discovered an additional problem. When the patient receives an Explanation of Benefits (EOB) from Medicare or the Insurance Company one has no idea what was done to you in the hospital, or what medication you received.(see Dr. Augus Deaton letter). A patient told me that he received all generic drugs in place of his prescribed brand named drugs while in the hospital. I would suspect the hospital wanted to save money. However, was that DRG charge built on generics drugs as opposed to the brand name drugs ordered? I would suspect it was on the price of the brand named drugs although I will never know.
Remember Denise’s story. Denise had no power to negotiate anything. She paid retail for everything.
It is up to us to demand that opacity does not evolve to semi opacity to appease us. Semi opacity is worthless and does not help the consumer with prices. The system must go directly to real and accurate Price Transparency. Consumers (patients) have to be in a position to negotiate price. If they can not they can walk with their feet . This is the definition of “Patient Power.” Why are Americans buying Toyotas and not Ford, GM or Chrysler cars? We own the purchasing power. We figure out how purchase the best buy giving the best value for our hard earned dollar. My goal is to help you figure out how to do the same in healthcare.