Friday, March 25, 2011

Bill Me Now, Please!

Recently I was at the doctor's examination room with a child, where the person from the billing department had followed me and was discussing copayments. (The new law has completely perplexed our doctors' billing department's in the area of copayments). The doctor arrived to treat my child, and he made some comment about having no idea about billing -- he just treats the patients and leaves all the payment issues to the billing department. I thought this was odd -- not that he should be handling the bills, but that he had no idea of the costs associated with his job and does not wish to know. He considers billing beneath him. That's fine (I have no interest in billing either and would hate to run a billing department). But still, we should all know what our medical care is costing us -- the doctors who provide the care, the patients who receive it, as well as the insurance companies who "cover" it.
Speaking of insurance, with insurance policies today, doctors generally order a myriad of tests for a vague ailment, and I as the consumer have no idea of the cost. There's never a mention of cost, except as to a concern whether insurance will "cover" it. We just hope that we have "good insurance".
After undergoing a series of tests, most of the time I hear only that the test was "normal" or whatever, but this is only after a phone call. I never receive paperwork (except the stray postcard with a "check" for "normal"), an email, and I have never received the results of an actual test. Although, admittedly, after receiving an MRI, I did skulk over there once to request a copy for myself. (There's nothing like having a creepy picture of one's skull stashed in the closet). Then insurance mysteriously "covers" the test, except that we'll occasionally receive a stray bill from the doctor or test facility, which we then spend a few weeks or months trying to "deal with" -- which means trying to get the insurance company to "accept the right code" from the doctor's office. It's a strange system. We'd at least be better consumers if we actually received a statement of the costs -- perhaps even before undergoing a fancy test.
Speaking of billing and doctors, it would also be nice to be able to actually choose a doctor whom we like. Recently I was speaking to my mom about building up her practice and I suggested that she put her legal track record on her website. She could mention cases won, describe issues she tackled, Vermont Supreme Court experiences -- that sort of thing. "Oh no!" she said. "I couldn't do that. That violates the ethics rules. You should know that!" I guess I should, being a lawyer and all (no, I'm not practicing -- it's been a few years). So in the legal field, people apparently choose their lawyers based on hot tips, and I guess if they want to comb the court records, they could piece together a case for who's "good".
With eight people in my family, choosing a doctor is similar, but it's also nearly impossible. We are supposed to have "choice", but woe to the person who actually has a specific doctor in mind!
I am always looking out for a great doctor. When I get a tip from someone, I call the office in question to see if we can start seeing that doctor. Rather than hearing a gasp of delight at the prospect of a new patient, every time I hear "She's not taking any new patients". And yes, it's usually without the "sorry" part. Then there's an uncomfortable pause and then... the question whether I would like another doctor. And then I'd like to say, "Yes, who's good?" But of course, that would be inappropriate and I wouldn't get a good answer anyway. I'd get something like: "All our doctors are good. They went to medical school, after all." Or something like that.
Here's the secret: not all doctors are good. Not all lawyers are good. Not all plumbers are good. Not all teachers are good. Not all librarians are good. Not all pastors are good. There is a difference in skill level and interest among people in all fields. Some people are devoted and enthusiastic in their work; some look at their jobs as something to get through -- and that applies to professionals as well as to everyone else. I want to be able to pick the doctor who's good -- and not have to base it only on a tip from a friend, the age of the doctor, or the doctor's medical school (this is the extent of information I seem to have available), or on whether the doctor is "accepting new patients." I think opening up our healthcare system so we all know costs and actual prices charged and allowing us to share information openly about quality so we can figure out who's good is a terrific idea. I am opposed to regulation, but I support access to information. As consumers of medical care, we should know who our doctors are and what our medical services, from doctors' visits to medical tests, actually cost.

1 comment:

  1. Unfortunately the trend in government health care is to move away from a "fee for service" type of billing to a "pay for perfomance" system. "Performance" will be measured at an organizational level. (i.e. Accountable Care Organizations)with broad criteria like how well costs are controlled, how many hospital readmissions have there been, etc.) The true costs of procedures will be even harder to discern and provider compensation will depend more on meeting cost targets than on meeting patients' needs. Very troublesome.