5. Lean HealthCare: Is based on Deductibles and Co-Pays on Every Procedure

by admin on 11/05/2019 5:15 AM

Over my 45 years in the private practice of medicine the excessive costs we daily observed were primarily related to patient demand for additional unnecessary consultations; additional unnecessary laboratory testing; additional unnecessary x-rays; CT scans, MRI scans; additional unnecessary hospital days above that which was necessary for making the diagnosis and begin appropriate treatment.

We had one patient ready for discharge on Dec. 23, but she claimed it was cruel to discharge her the day before Christmas when the family expected guests for the holiday. She felt that an extra three days in the hospital would be kind and considerate. She didn’t believe it would cost anything. But an extra $1000++ per day, even if covered by her insurance, is very expensive house sitting. When patients are not aware of the charges, who can blame them for wanting an extra $3,000 to cover conveniences? Patients who are insulated from the costs have no comprehension of how much their health care expenses mount up. They could easily double or triple their health care costs with these requests as they try to influence their physicians.

In the current environment, physicians have a difficult time reducing the costs to that which is necessary. They have a hard time playing policeman. Insurance has defined their subscribers as “members” and they actually feel that they are members of the healthcare family. Therefore, they are able to tell their insurance carrier that their doctor is not ordering the appropriate necessary items, that their physician is pushing them out on to the streets. The physician may actually be conserving costs which is in the insurance carriers’ interest. Still, the carrier may order an investigation of the doctor which requires extra time by the physician and is always “pro bono.” Physicians do not want to put salt in the wounds and will play the game. This is to reduce the cost of a possible malpractice lawsuit in which no malpractice occurred. These pro bono costs can easily exceed or even double the cost of the physician’s charge for the entire hospitalization. Many physicians are in practice for themselves and thus every cost is a reduction in his bottom line. If he is part of a group, it reduces the bottom line of his group.

A simple statement by the physician can be interpreted as legally damaging by the legal system. Most liability lawyers recommend that physicians do not respond to the hospital or their insurance carrier attorneys. They are not a physician’s friend even though they may appear to be friendly. They recommend that all allegations be referred to the physician’s personal lawyer who should be a specialist in physician/hospital/insurance affairs. The lawyer will take several hours to review the case, spend time with the physician and will normally charge 8-12 hours on a simple problem. At $400 an hour, this can easily cost the private physician $4000 to $5000 per allegation. These costs are unseen by the public, but can add up significantly. This is a major cause of the increase in physician bankruptcies.

This scenario can be essentially avoided by having the patient involved in a complete disclosure of the planned risk/benefit discussion which may not be comprehended if the patient does not have a stake in the decision-making process. Having a stake in the decision-making process is not only important to the physician’s liability, but also to the cost of healthcare. That’s why a yearly deductible and a co-payment on every step of the healthcare process is critical to the control of healthcare costs.

With the patient involved early in the decision-making step of the doctor/patient relationship, the patient will be conversant with and accept the liabilities of every decision. He will seek to keep the costs under control since he will be paying, in our recommended HealthPlan, 10 percent of hospital costs. The patient will no longer ask for additional consultations, x-rays, CTs, and MRIs because for every additional $1000, he will be paying  $100 according to our recommended plan. On the basis of our personal experience with this approach, this will reduce healthcare costs in our country by half. There will no longer be any need for healthcare insurance to cover routine care since this will now be affordable. Costs double when a third party is involved in payment who knows very little concerning the medical issues.

Private insurance or even Medicare can now devote their time and energy to cover acute medical care such as strokes, heart attacks, and cancer that require hospitalization, as well as trauma, surgery, and other emergencies. The cost of Critical Care and High deductible insurance for these problems generally is affordable. This may be an intermediate step to make all of health care affordable.

That may be a step too far or too fast since most people cannot perceive healthcare as being affordable. So it will take some time for this to be realized—certainly not by the 2020 or the 2024 elections. Therefore, use caution in the upcoming elections so you don’t torpedo affordable basic healthcare which is only three- or four-hundred dollars a year. The only issue should be the major medical/surgical/trauma/hospital care which is the thirty- or forty-thousand-dollar variety. To mix these two makes all of healthcare unaffordable.

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