Whether prompted by the Affordable Care Act, active third party insurers or natural evolution, there is a sea of change in costs faced by patients of health care providers.  Otherwise known as CONSUMERS.  Regretfully, as patients face larger and larger personal  financial responsibility for the use of health care, they are ill equipped with the information and habits which normally promote good consumerism.  This article addresses what Patients and Providers can do to more effectively participate in the new world of health care reimbursement.

As reported in the Wall Street  Journal, health care in 2016 now represents 18.2 % of gross domestic product, up from 13.3 % in 2000.  Perhaps more notable is the increase many families feel in their incomes dedicated to health care.  A Brookings Institution study found many households now devote the largest share of their spending to health care, 8.9%, or a rise of more than 3 % from 1984 to 2014.  This increase results from many factors, including higher insurance premiums, more costly procedures and medicines and, largely, much higher deductibles.  The percentage of household income used for food, housing and clothing has all declined in the comparable period.

Medical costs to consumers take many forms.  For those who have never enjoyed the “benefit” of insurance, this might be as simple as a direct payment to the health care provider for the listed price of their service.  Or, is it that simple?  A “routine” visit to your local Emergency Room–and there are  over 135 MILLION visits to an Emergency Room annually in the United States—often involves many individual providers and many listed services.  For instance, there can be the visit charge by the Emergency Physician, charges by a Radiologist and a Pathologist if testing is necessary, separate charges by the Hospital for the use of their facility and their testing equipment (that is correct, physician and facility charges are different!) , charges for medicines, charges for supplies, and on and on.

With all of this complexity, confusion and cost, what can be done?  A few simple, and some not so simple, suggestions to lessen the frustration of utilizing health care in today’s environment follow.

For the Patient.

First and foremost, act like a CONSUMER and ask the price.  Do you think of buying groceries, or a major purchase such as a car, without asking the price?  For the patient, asking the price of a medical service needs to become habit forming.  Too many patients readily agree, or request, a procedure such as an MRI with very little appreciation of its cost.  And this is not a trip to the grocery; an MRI often can lead to a patient being responsible for $5,000 or more.  Perhaps knowledge of the cost will help evaluate the true need for the service.

Second, understand that the “list” price of a procedure is often negotiable.  Many, many providers appreciate that the published price of their service is seldom a function of their cost and sincerely wish to make their “work” affordable.  If you, the patient/consumer, are personally responsible for payment, providers are often willing to accommodate you through discounts, extended payment options, even changes to treatment protocols.

Third, consider the effectiveness of your provider.  If you are regularly “prescribed” expensive procedures that might seem questionable after discussions with friends or other providers, or often require repeat visits, it might be time for a change.  Get value for your money.  If you go to a car repair shop for new brakes and they also want to sell you new tires, you question them.  OR, you select another car repair shop the next time.  Be as engaged in selecting health care “shops” and services.

For the Provider.

Many, many providers are already involved in assisting their patients with navigating through difficult reimbursement processes.  This often involves pre-authorization of procedures and verification of insurance coverage .  Yet, as greater and greater financial responsibility falls on the patient, more can be done. The MOST significant step towards a better understanding with your patient regarding all of these issues is communication.  Inform the patient of their cost of procedures before they ask; inform the patient of their options on alternative treatments and risks; explain the variety of charges they may receive from your recommended plan of action;  help your patient BE a better consumer.

Some very basic tools to consider for more effective communications are: Published fee schedules (standard charges for the most common procedures); A web site explaining more common procedures for your specialty/practice and related efficacy; A comprehensive data base with your patients’ e:mail addresses.  If your practice has received quality awards, or your providers have been recognized as experts, include this on your web site.  Understand that cost and “competency” topics are often difficult for a patient to discuss, given the extreme trust many of them place in their physicians.  The more a provider can encourage this interaction, the better for all.

A final consideration for Providers is to maintain flexibility in payment requirements depending upon the patient’s circumstances.  For instance, patients who are uninsured likely deserve the same, or better, discount from the standard fee schedule than does, say, United Health Care.  Recognizing this before sending the first statement goes far in creating an even deeper relationship with the patient.