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Readers Write: The Engaged Healthcare Consumer is a Myth

May 7, 2014 Readers Write 4 Comments

The Engaged Healthcare Consumer is a Myth
By Tom Meinert

Although I am a reader, this may be more appropriately titled “Patient Writes.” I have been feeling cynical lately regarding healthcare. It seemed to culminate with a recent experience with my health insurer.

My daughter had to get an MRI. Shortly thereafter, I received the bill for my portion and it was a nice, whopping $1,000. Aside from the sticker shock, I was surprised because I had an MRI about a year and a half ago and I only had to pay $400. It’s the same Insurance plan for both of us, and although the MRIs were done at different places, the difference of the sticker price of the MRIs was $250. I was expecting to pay a bit more, but somehow a $250 difference actually cost me $600 more out of pocket. 

I called my insurer. After 40 minutes, I learned the following.

  • It’s not just what the hospital charges, but how they bill it. That may significantly change how much I have to pay out of pocket.
  • The people I call don’t have the information about the true cost to me.
  • Even if they have this information, they can’t share it with me.

This call confirms what has bothered me all along. Despite all the talk and hype regarding patient engagement, consumerization of healthcare and mHealth ushering in a whole new world along with the ACA, the concept of an engaged and informed consumer of health care is a myth.

I have worked my entire professional career in healthcare IT. I believe it can help change it for the better. Admittedly, most of my time has been spent working on projects that help improve care within a hospital.

But the more articles I read, conferences I attend, and apps I play around with, as I compare my own experiences as a patient, I am not impressed. Even more, I can’t see how healthcare is going to fundamentally change for the better.

I am frustrated and powerless. Over the past four years, my health has improved greatly. I have lost weight. My cholesterol is way down, along with my blood pressure and resting heart rate. Yet over this time, my personal out-of-pocket costs and premiums have increased.

I live in Massachusetts, which is at the forefront of healthcare reform. I can’t see a PCP without booking nine months in advance. I can see them only once every two years because that’s what insurance covers for a well visit.

Like more and more of us who were pushed into a high-deductible plan, I can only begin to empathize with patients who have complex problems who try to navigate the world of billing.

I hardly feel as though I am a consumer of healthcare. The truth so far seems to be that the definition of a healthcare consumer is simply proportional to the amount of costs pushed on to me. The more out-of-pocket costs I have, the more of an engaged consumer I am.

However, pushing costs on to me certainly does not make me an empowered and informed consumer. And it certainly doesn’t incentivize me to be healthy.

Going back to my phone call, it ended as expected. There was no real resolution. I still have to pay the bill. 

Those calls are recorded “for quality,” so I included one last comment out of frustration. Despite this company telling me that they have no real way to get at this information, someone there has it readily available at all times — the person who sends out all those bills that are accurate down to the last cent.

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4 Responses to “Readers Write: The Engaged Healthcare Consumer is a Myth”

  1. 1
    Greg Park Says:

    Good read Tom! I suspect this is why I have heard from some in healthcare that the only real fix is to place the complete onus of payment on the patient, i.e. the patient pays for all expenses directly. Though this would be devastating for many, it would create an atmosphere of competition where providers sought to have the best outcomes at the best price. Imagine if we had full transparency into the cost and could compare between providers in our region.

  2. 2
    Greg Park Says:

    Also, your point is well illustrated in the dismal appeal of patient portals (to patients). Vendors and providers will tell you they are successes (because they help achieve MU requirements), but in reality the sign-up rates are small, and return visits are lower yet.

  3. 3
    Patrick Creagh Says:

    Love this post. Despite working for a payment automation company (Patientco), it wasn’t until I had ‘that’ billing experience you just described that I could truly appreciate our mission. That said, no matter how convenient we make the payment process, that won’t change our odds at the price tag slot machine. I’m not sure if we could handle the rather dramatic shift to a straight free-market model, but there should at least be some sort of standardization of list prices so identical procedures don’t fluctuate by the hundreds or thousands. Then patients wouldn’t be so befuddled every time they receive a bill as we see so often.

  4. 4
    AC Says:

    At the very least the federal government should mandate that all prices for all procedures be public and known to the patients well in advance. Of course, you won’t know what actually got used until after the procedure, but there is no reason not to know in advance what the prices are.

    I would also like to see the prices be the same whether it’s for an insurance, Medicaid, or private individual.

    Just mandating these two points should help alleviate most of the issues.

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