Sticker Shock in Healthcare?

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article. 

Eight weeks ago, I had a total knee replacement. My left knee succumbed to years of wear and tear, punctuated by a ski accident and old football injuries. I joined the ranks of 720,000 who will have the procedure this year.(1)

I’ve been a student of the healthcare industry for 40 years. Surveys have consistently shown that most U.S. health consumers base their opinions about the system’s performance on their personal experiences, not a studied view of its performance based on data and facts.(2) I understand why. My knee replacement has been a teachable moment.  Here’s what I have learned:

  1. Healthcare is expensive, and the costs catch you by surprise. Thus far, charges for my experience exceed $70,000 including $303 for a 15-minute visit with a cardiologist to assess my risk, $51,829.35 for the 55-hour stay in the hospital, and $135 for a walker I used for three days. Relatively speaking, the $8,698 charged for the surgeon and anesthesiologist are a bargain, but these are charges. I have no idea what my actual out of pocket payment will be: bills are first sent to the insurer. Eight weeks after my procedure, I am still getting bills, and I am clueless as to what the final tab and my portion will be. Sticker shock in healthcare is increasingly an issue. Yesterday’s New York Times page one headline captured it well “After Surgery, $117,000 Bill from Doctor He Never Saw.”(3)
  2. The system still operates on a volume basis: The bar for service delivery, patient satisfaction, and optimal patient experience is low. I received a survey within three days from the anesthesiologist and another at four weeks from my surgeon. But no one in their offices e-mailed or called to see how I was faring, so it seems quite clear I am “just a number.” While in the hospital, caregivers are busy doing their jobs. They have little time for TLC, and after leaving the hospital, any interaction is at the prompting of the patient, not the proactivity of the care team. Consumers value good service and resent poor service. I find myself keenly aware we accept a lower standard of “good service” in healthcare as the norm. Disappointing!
  3. The outcome is dependent on BOTH the clinical team and ME. I studied “total knee” before my procedure, and understood that my post-operative activity—rehab, exercise, icing, et al—is key to an optimal outcome. But now I know how much my role matters. As hospitals and physicians become risk takers in accountable care and bundled payment programs, their effectiveness in managing and monitoring MY ADHERENCE will be increasingly important. My impression is providers fall woefully short in taking that role seriously or performing effectively. But at the end of the day, optimal outcomes are the product of clinical expertise by well-trained care teams and patient adherence: it is co-dependence!

This experience is teaching me a lot about our health system. I am walking a little better every day—that assures me our clinical prowess is solid. But I find myself wondering, why we as consumers, are content to allow our health system to fall short in so many ways. We can do better.

Paul

(1) National Center for Health Statistics, Centers for Disease Control and Prevention, cdc.gov
(2) Deloitte Center for Health Solutions, 2012 S
urvey of U.S. Health Care Consumers, deloitte.com
(3) Elizabeth Rosenthal, “After Surgery, $117,000 Bill from Doctor He Never Saw,” New York Times, September 21, 2014

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

© 2014 Navigant Consulting, Inc.