One would think that a physician who earns his living billing patients would be conversant with the prices of his services. Not this doctor. I am queried periodically by patients asking how much I charge for a colonoscopy. Of course, every physician recognizes that this question is not phrased properly. It doesn’t matter what we charge; it’s what an insurance company determines we will be paid. I might believe that your colonoscopy was worth a thousand bucks, but those who pay the bill have a different sense of its value. Many ordinary folks think that we doctors can simply raise our prices to enrich ourselves. Physicians cannot do this. The hardware store and the supermarket can raise prices in response to rising overhead and market forces, but we physicians cannot. While I realize that the public does not sympathize with physicians who are lumped in with the 1%, a pejorative term popularized by the Occupy movement.
The reality is that many private medical practices are struggling financially and have closed. Many of these practitioners have retired and others have become physician employees. Our practice in the Cleveland suburbs is feeling the squeeze and I cannot estimate how long we will remain viable. Personally, I believe that private medicine is being targeted by design, and when it becomes extinct, the public will lose an important health care resource. While I am not opining that private practice is the only model that can offer high quality medical care, I maintain that when the physician is also a business owner, that he has a strong incentive to satisfy his patients and his referring physicians. Employed physicians are given incentives, which are metrics that reward or punish them depending upon how the measure up on various ‘quality’ schema. Throughout this blog, I have railed against pay-for-performance and its cousins which claim to measure medical quality, but will fail in the mission. It’s like assessing the quality of a chef’s culinary creation by weighing the plate of food. Get the point?
Pay-for-Performance is in the lowest tier of the bottom 99% of quality control measurment. It was not designed to increase medical quality, but to control costs, which is a legitimate goal. At least have the guts to say so out loud.
I don’t have a clue what a colonoscopy costs. This is partially because I have never been interested in the business of medicine. However, colonoscopies are like airline tickets; no two passengers pay the same fare. Insurance companies have different rates. If we obtain biopsies or use a nurse anesthetist to administer the Michael Jackson juice before colonoscopic take-off, then there will be additional charges that cannot be firmly stated in advance.
When I do see what we are paid for a colonoscopy, it certainly doesn’t seem exorbitant considering the years of physician training and experience we have, the outstanding nursing care we provide, the immaculate and modern facility and equipment we use and our devotion to providing the highest quality service possible.
Who can put a price on an experience like this? Not us.
Well, somebody puts a price on it and it sounds as though a surgeon is totally aloof to his patient's concerns when you say that you have no idea what a procedure costs. Of course there are variables with each case, but you should be able to at least give a ballpark figure for the practice that pays your salary. To say that no-one can put a price on your education and experience and quality staff is ridiculous. If you know your patient and you know that you are going to prescribe a colonoscopy, why not find out what their insurance is going to pay you or charge the patient before you even see the patient? Don't you know how expensive health care has become? Don't you know that many patients have no health insurance at all? Don't you realize how worried many patients now are, what with mortgage foreclosures and high unemployment? Or do you see yourself as above all that?ReplyDelete
I am outraged that doctors have little or no compassion for their patients and the pressures that they face.
We are past the time when we can be oblivious to prices of procedures, office visits and tests. Most patients now pay a significant share of the visit through high deductibles and copay. Employers can no longer afford double digit price inflation each year so they adapt by offering policies that put the burden on the patient.ReplyDelete
As physicians we must get involved in the business of medicine. I have been a proponent of price transparency. Insurance companies need to get rid of the small print and difficult language in their 50 page patient handbook. Doctors need to know low price labs to send patients to and should al least give a "range" of what a high price procedure like a colonoscopy could cost. Also there is no reason to have an anesthesiologist present. That just drives up cost and is not done anywhere else in the world.
thanks for a thought provoking post.
@classof1985, thanks for the comment. I am puzzled that you infer that my view suggests a compassion lapse. Moreover, your comment that 'no one can put a price on your education and experience' reflects a view that does not appear in the post. I agree with you and with Toni that there needs to be transparency of medical pricing throughout the medical universe, particularly in hospitals.ReplyDelete
I agree, Toni, that nurse anesthetists may be over utilized, but for a subset of patients, this is absolutely necessary.
Try asking an emergency room how much your visit will cost in advance and you will encounter medical pricing at its most opaque level.
Patients would be shocked to know that just walking into an emergency room in my area (SF) will cost $1200 minimum. That's for a cold, a rash,a headache, a sprain. Price goes up from there...EKG (ching, ching),Xray (ching,ching) blood test (ching,ching). Easy to walk out with a $2500 bill for a simple problem.ReplyDelete
Doctors fees are on top of that...billed separately.
Yes, health care is crazy expensive. Urgent care clinics could do most of it at a fraction of the price if people would use them.
Our country has put no focus into bringing down the cost of care, except to fiddle around the edges with capping prices and making it difficult for physicians to practice medicine.
How do other countries do it? They focus on primary care and support it 100%. They make it easy for patients to get service 24/7. They care for mothers and children and have treatment for drug addiction. They don't spend all their money on the military.
Call it socialized medicine if you wish. I call it smart use of $$$.
Let's not get into what the ER charges -- I'm not going to the ER to get a colonoscopy -- I'm coming to your office on the recommendation of my primary care physician. I probably had to make an appointment a month or two in advance to see you, because I'm "not that sick" but I'm in that age bracket where it could be something, diverticulitis or who knows what. Your office has the heads up that I'll be coming in. They have my telephone number and can call me to ask about insurance. And I can tell them that I have BC/BS with a $3000 deductable that I haven't met yet. So, right away your office knows that I'm gonna be the one paying for the procedure when all is said and done. Needless to say, I haven't had this done before so I have no idea if you charge me $5000 or $10,000 or $100,000 and I'm not too crazy about the procedure to begin with. So when we're sitting in a small room, me in a gown made of Kleenex and you, fully dressed, and I don't know you and you don't know me and yet you're gonna be messin' around where no one has ever gone before. And you can't even give me an idea of what this is gonna cost me? You've had weeks to find out! I have nowhere to look to find out. And, after all, colonoscopy is a diagnostic tool. You're gonna find something up there so this is not just gonna be a hit and run, you're gonna play a larger role in my life for the next few months at least and so I would think that you'd want to be on my good side, so to speak. I'm terrified and I just read an article yesterday about some kind of bug that lives in the bowel that can be deadly. You think you can just brush me off with a few platitudes?ReplyDelete
@Classof65, well done! Appreciate yourReplyDelete
points and your pointed remarks. Are you suggesting that we add to the tsunami of absurd paperwork we endure. Yntruing to divine in advance the costs of procedures for patients who all have different insurance plans, deductibles, etc? This is not akin to pricing a gallon of milk at the supermarket.
We all have to get a colonoscopy after age 50 because Katie Couric's husband died of colon cancer.ReplyDelete
I'm here kind of late, having just recently found this wonderful blog, but I thought I would add a link to a website that might help consumers do some price homework prior to medical services. FairHealth Consumer Cost Lookup provides an estimate for the cost of many procedures, allowing for various insurance scenarios. I don't have any affiliation with this non profit organization, but I thought a link to their website might offer some help in this discussion: http://www.fairhealthconsumer.org/ReplyDelete
Thanks, Charity, for your comment and the link. Hope to see your views on other posts.ReplyDelete
Sorry to chime in so late, but this post really got under my skin. I have been disabled for about two years. As a result, I get a small, private disability insurance check each month, and I have no health insurance. My ex-husband took off with a girlfriend years ago & has mostly dodged paying child support since, but he does provide insurance for our four kids. Really crappy insurance, by the way. He doesn't cooperate with the filing of claims or following up on requests for info, and he rarely pays his half of medical expenses. So that leaves me footing a large portion of the bill for stuff like, say, colonoscopies. Two of my kids inherited the same condition I have, and a few days ago, one started filling the toilet with bloody diarrhea. I have no idea how I'm going to pay for this, but obviously, I've got to get my baby stable again. While waiting for her GI referral to go through, I started searching for the cost of colonoscopies, & I stumbled upon... this. Why does it matter that you understand the business end of medicine? Because your patients aren't just bodies to explore. The symptoms they are experiencing are only a portion of the stress their illness creates in their lives. Because not all of your patients can afford necessary medical care, and some of them are falling through the cracks. I would never suggest that you need not be fairly compensated for your education, experience, or work. For your part, you need to know what that fair compensation actually is. Anything less absolutely shows a complete lack of compassion for the patients struggling to come up with the money to pay you.ReplyDelete
This post is a perfect case study on why healthcare costs are breaking the system.ReplyDelete
Dr. Kirsch sniffs at the idea of understanding the business side of medicine. You're a dying breed, Doc. If you don't prepare to answer "how much is that?" questions, you'll lose all but your Medicare patients over the next five years.
The health insurance marketplace is undergoing a seismic shift, and not just because of the ACA. Healthcare costs have been chaos behind a veil of secrecy for four generations now - which will come to a halt as companies stop offering health insurance benefits to their employees.
That shift has already started to rumble, with Sears and a few other large employers telling their teams that they are no longer in the health insurance buying business. They're handing the keys to their employees, helping them figure out how to negotiate as a group; they're helping their teams build a reserve to help pay for healthcare costs with HSA payroll deductions; however, they are no longer buying and administering group insurance plans.
Health insurance needs to return to its original purpose: risk management. We should be paying for our own preventive and screening care. Buying insurance as a group should not be available only to employees of large corporations - all of us should be able to find at least a couple of groups that we can join and negotiate with for affordable health insurance policies.
My car insurance doesn't pay for oil changes. Homeowner and renter insurance doesn't pay for washing the windows. We should be paying for our own checkups and screening procedures, directly to the clinicians performing them.
Insurance should be what we rely on when we get a diagnosis beyond "see you next year."
I live in Los Angeles, CA, and am 57 in age. I will be paying $600 for a colonoscopy. 5years ago when I had insurance, I went through them and cannot recall what the crooks got.(Ins company) yet this Korean town Dr. notified me with a letter and phone call to gently remind me of 5year follow up. I informed them that I no longer have insurance and the case Mgr. Explained that it would cost $600. Still, more money outReplyDelete
my pocket yet all things considered, I feel it's fair. This is with the Mikael Jackson med.
I have been utilizing minority doctors lately and been treated fair for the most part.
I just got billed a total of $18,000 to my insurance for the total procedure. I had 4 pollups removed. How does this make since?ReplyDelete
I had a colonoscopy with polyps removed. I have insurance and paid $0. But my insurance company paid over $18,000. I wrote them that a mistake had been made, but they insisted it was correct.ReplyDelete
Wow! How can I be on that insurance panel!?!ReplyDelete
Today I cancelled a colonoscopy appointment. I was referred by my primary care physician to a gastro group, who said it would take a month to even get in. So today they call me about the prep, prescriptions etc and also inform me that I will need to bring $750 due to my deductible is not met. I say "Up front?". They say this should've been taken care of already. I proceed to tell them that I'm not able to pay this kind of cash up front. They refer me to "Care Credit". I thank them and inform them that due to losing a pretty decent paying job 2 years ago and living pretty much on credit, I dont believe i would qualify any longer. I am currently working, and thankfully, I do have insurance, but I am making nowhere near the money I was 2 years ago. I consider myself among the blessed to be able to pay rent, utilities, car insurance, groceries, etc (the basics).ReplyDelete
I think doctors should be compensated well. I understand that modern equipment and quality care cost money. It just seems like $750 is a huge obstacle for me and I don't forsee being able to come up with that kind of cash any time this year although I am looking for other jobs and part time work as well. Meanwhile, I continue to have that gnawing "what if" worry that something really major is wrong with my health, otherwise my primary wouldn't have recommended this procedure for someone under 50, right?
Well, I'm off to see what programs may be available, but as a single childless working woman, it doesn't look promising. I appreciate this blog and hope it didn't come off as a "cry me a river story". It seems like having insurance, "good insurance" even...has been of no benefit.