As a Board Certified Emergency Medicine Physician of 13 years, I have had the privilege of sharing some of the greatest moments of my patients’ lives with the “great saves” and also been there for what I consider to be the worst times – to me the most heartbreaking thing is to have to tell another parent that we weren’t able to save their child.

And like most of my fellow physicians, we were so buried in the hustle and high of patient care that somehow we let healthcare become the nightmare it is now.  I have to say to my fellow doctors — much of how bad the system is largely our fault.

The fundamental relationship in medicine is the doctor-patient relationship.  That is the core reason that so many of us went into medicine.  We allowed all these other players to get in between us — health insurance, Medicare, core measures, Joint Commission.  I simply can not believe that I am the only physician who thinks that the amount of time I spend charting requirements that the government thinks is important but clinically irrelevant is insane and so counterproductive.

In a time where we project a shortage of physicians and where healthcare costs too much — why are we spending more time in front of a computer and less time with the patient?  What used to be a 50 second paper chart is now a 7 minute encounter of sitting in front of a computer with the overpromised and sorely underdelivered electronic medical record.

There was a time still in the lifetimes of some that the doctor-patient relationship was just that.  Patients had problems, and doctors took care of them and patients paid for their care.  There was no shortage of healthcare and the relationship was really full of the most important part of that word — care.

We, yes, we as physicians have allowed all of these powers-that-be to have too much say and interfere with that relationship.  And I would suggest to you that it’s not too late — that we can take that power back.  So to my fellow doctors…. and to my fellow patients…   (yes, all of us doctors are all eventually patients too) — just say “no” to all the others who want into our celebrated relationship — they don’t need to be there.

David Wong, MD

Diplomate, American Board of Emergency Medicine

CEO/Co-Founder – SnapHealth.com – the healthcare marketplace that matches patients and doctors without all the noise of complex coding and reimbursement burdens.

During the weeks and months surrounding the passing of Healthcare Reform, one of the constants from the administration was that the current mess was a direct result of an unregulated market. That not only could a free market not help the current healthcare system, but it was in fact the anchor pulling the system into the abyss.

Now, it is hard to argue that the current system is not badly broken. Given that there has been very little government involvement in the private sector, at least on the surface, it would appear that the free market has failed us… This got me to thinking, what is a free market? As I thought about it, I realized that the term free market is one of those phrases that we often use but, if put on the spot, few of us could give an accurate definition…myself included. So like most people, I went to the internet and what I found was pretty surprising. The definition of a free market is:

A system of economics that minimizes government intervention and maximizes the role of the market. According to the theory of the free market, rational economic actors acting in their own self interest deal with information and price goods and services the most efficiently. Government regulations, trade barriers, and labor laws are generally thought to distort the market.

Now regardless if you find yourself in an Elephant or a Donkey camp, or for that matter somewhere in between, even my second grade son can read this and with very little explanation determine that in fact the free market has not let us down. If anything, we have let the free market down.

The first phrase that jumps out at me is, “economic actors acting in their own self interest deal with information and price goods and services the most efficiently”.

Well, for starters, the current economic actors are the insurance companies and through Medicare, the Federal Government. This brings us to our first dilemma, the “economic actors” should be the doctors and the patients, as they are the ones who are buying and selling the service. Instead, two major poorly run organizations have taken the seats of power and in this case have assumed the role of “economic actors”.

The other issue, as it pertains to the “economic actors”, is the phrase “deal with information”. Not only have the wrong economic actors taken control of the system, but also they have made it next to impossible for the rightful owners of that power (that would be you and me) to have any of the information; we actually need to make an informed decision.

The second phrase is a bit more covert without knowledge of the inner working of the current healthcare system. On the surface it would appear that the government has largely stayed out of the private market, however when you understand how prices are currently set. You will quickly see that once again; we do not have a free market. All pricing whether you need a wart removed or need to procure a new kidney begins with what Medicare reimburses. Those rates are then multiplied several times over so that then the insurance company can negotiate a large discount and then market that discount to employers in the form of health insurance. This creates a problem with our so called free market because Medicare rates are not set based on normal economic principals around supply and demand, rather it is a mix of lobbyist and government officials. At no point in the process, does anybody ask the key question which is, “how much does this actually cost?’

Caught in the middle of all of this is the doctor and the patient. So the question is, “Why can’t a free market save healthcare?” Healthcare is the only service I can think of that the person buying the service and the person selling the service has no idea of what it cost. Furthermore, even if the patient wanted to ask about the cost the doctor would have to ask a third party. Seems odd to me…how about you?

What if we changed all that? What if the true economic actors (you and I) took back the power? Would the mechanics of a true free market not fall into place? When I encounter a service or product that meets are exceeds my expectations of performance and my price point I leave that experience with a feeling of satisfaction. When was the last time you had a healthcare experience that was truly satisfying?

I think we can all agree that we need reform. I also think that most people believe that healthcare should be affordable to everyone. After a review of the definition of a true free market, I think two things start to happen 1) We quickly realize that we are now farther than ever from having anything close to a free market and 2) It is tough to say that the free market has failed, since clearly it does not currently exist. I say give us the power to shop for the care we want, give us a price we can afford, tell us what the price is before we buy and don’t give me any surprise charges. Now that would be a satisfying experience and that would be a free market.

Image courtesy of healthyvoyager.com

Along the way, the payment of healthcare got very convoluted inadvertently by the advent of the third party payer and health insurance companies becoming intermediaries for payment and the cost of care spiraled out of control.

With the Affordable Care Act being upheld, many are realizing it may not be everything that was promised with over 60% of clinicians have a negative or unfavorable view of how it will affect care or control costs. In addition, the IRS recently released that they expect the least expensive plan on the exchanges to be $20,000 a year for a family of four.

So patients now are getting even more engaged — and really, it should have been solved this way all along. The cost of care never needed to be a bad word in the context of medicine. Really, would you rather have the discussion about whether the cost of a test or procedure is worth it between the doctor and the patient or mandated by an insurance company or government regulator?

The issue of price transparency in healthcare is coming back into vogue through sites such as clearhealthcosts.com and healthcarebluebook.com — and of course, the one that makes the buying experience simple — SnapHealth.com.

Patients who are willing to be engaged in the price discussion also tend to be the ones who are most involved in their care – the ones that doctors often love to have. First they understand that there is financial value attached to the physician’s services and second, they care enough about their health to ask comprehensive questions and take on more responsibility in their care.

As a physician, I welcome these patients — they’re engaged — as a physician of the 21st century, I don’t view my role as paternalistic but as a team member with the patient — and having an empowered engaged team member always leads to better results.

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One interesting response to this dysfunctional, shadowy system is the recent proliferation of direct medical care practices. These work by providing patients with unlimited primary and preventive care for a low monthly subscription fee. They cut insurance companies out of the loop entirely, and give patients a sense of security that there will always be someone to see them. Since insurance costs consume 40% of every dollar spent on insured health care, a system that does an end-run around the insurance companies has more money to put into the care itself. Doctors who participate in direct primary care report that they’re financially able to spend more time with each patient — not to mention the fact that there’s suddenly a huge amount of time freed up from not having to fill out insurance forms.

Direct primary and preventive care offers another benefit besides simply more time: it allows doctors to truly practice the creative art of healing. Freed of the elaborate rules imposed by health insurers which govern almost every aspect of medical decision-making now, doctors can draw upon their own personal skill to make care decisions, in conjunction with their patients. According to Direct Primary Care, a coalition of providers, this medical model is actually reinvigorating the practice of primary care, and drawing more doctors back into the field. Patients are empowered as well because they’re no longer supplicants; they know exactly how much they’ll be paying for their basic medical care (and primary care constitutes 90% of health care needs.)

This model then allows patients to carry a far less expensive health insurance policy, which covers only the costs of emergency and specialized care; furthermore, having experienced the direct primary care model, patients will feel more empowered to price-check their options when they choose a provider of specialized care. Direct primary care is just one of a number of brand-new approaches with the goal of bringing healthcare costs into the light of day.

SnapHealth also addresses these issues by connecting doctors of all specialties with patients that pay direct for care. SnapHealth features direct pay prices and patient reviews, so that patients can find the quality care they need at an affordable price. Doctors are thrilled because they have more time to spend with these patients since they don’t have to spend time charting and filing claims to get paid. They also get to keep more of what they make because the 40% overhead it usually takes to get paid by insurance now goes into their pockets.

http://www.californiahealthline.org/articles/2013/3/18/california-receives-d-grade-for-health-care-price-transparency.aspx

Not only does cost affect our wallets, it has adverse affects on our access to care, (too
high of costs limits lower income and middle class people from seeking needed care)
it also limits quality of care. We have all seen the result with some one we know who
waited far too long to visit a doctor because of cost, only to find a simple illness now was
a complicated medical necessity. And this is more commonplace than we care to admit.

This is the driving force behind our SnapHealth portal. To give patients the ability to
shop for care, with transparency for pricing and choose a doctor offering preferred
payment models, eliminating all the added costs of reimbursement from insurance
companies or governmental agencies (third parties)

Think of it as a Hotels.com for health care. We will find the doctors, post the services and
the costs, which can be as much as 70% less than if you used your insurance. Less out of
pocket (your money) and then you may be reimbursed per your policy directly from your
insurance or other third party. Less cost means less co-insurance, deductible and co-pay
expense (your money)

Our doctors and facilities are high quality providers looking for ways to take the burden
of high cost away from their patients while actually having more time to spend doing
what they trained to do, not paperwork trying to satisfy a bureaucratic quagmire trying to
get paid for the services they provided.

So if not a member now, join, it costs nothing to start saving. If a current member the end
of the year is upon you, if your deductible is not met and you want to use your remaining
balance intelligently and frugally, use our providers before the end of the year before the
whole deductible rolls over and yes increases

Below is just a sampling of why it is so important we band together to create our own
family of patient shoppers and providers’ services to help reduce the cost of care for all.

You can not afford to spend one dollar more for the health care you need and want, use
SnapHealth now and start taking back control of your own health care costs.

From “Best Care at Lower Cost: The Path to Continuously Learning Health Care in
America.” Report Brief. Institute of Medicine of the National Academies, page 4
(September 2012):

o

“The entrenched challenges of the U.S. health care system demand a
transformed approach. Left unchanged, health care will continue to
underperform; cause unnecessary harm; and strain national, state,
and family budgets. The actions required to reverse this trend will be
notable, substantial, sometimes disruptive – and absolutely necessary.
The imperatives are clear, but the changes are possible – and they offer
the prospect for best care at lower cost for all Americans.”

o

From Friedman, Milton “How to Cure Health Care,” Hoover Digest, 2001 No. 3
(July 2001):

“Two simple observations are key to explaining both the high level of
spending on medical care and the dissatisfaction with that spending.
The first is that most payments to physicians or hospitals or other
caregivers for medical care are made not by the patients but by a third
party – an insurance company or employer or governmental body. The
second is that nobody spends somebody else’s money as wisely or as
frugally as he spends his own.”

o

From Coluni, B., “Save $36 Billion in U.S. Healthcare Spending Through Price
Transparency,” Thompson Reuters (February 2012):

“As a nation, we urgently need to find solutions to stem the rapid rise in
healthcare costs. Our history of deeply insulating consumers from the
costs of their healthcare choices and the pervasive systems that obscure
visibility into the cost of services bear at least some of the blame for
year-after-year double-digit growth percentages for healthcare costs.”

“Price transparency tools that encourage more informed, financially
intelligent healthcare decisions, combined with benefit plans that are
designed to require more conscious healthcare choices by consumers,
will help create engaged, informed, educated consumers — and by
our estimate, save $36 billion (3.5 percent) from annual healthcare
expenditures.”

Studies show that healthcare costs for the same procedure in the same
market can vary by more than 100 percent. Providing consumers with
clear, comparative information on the cost of services is key to further
engaging them in the decision making process and, ultimately, reducing
healthcare costs.

Procedures that are elective, performed for conditions that do not
threaten life, and can be performed well in a variety of settings are
often the procedures most appropriate for price shopping.

When consumers are informed of treatment options and efficacy, they
make decisions that reduce overall costs and utilization.

Price is not necessarily correlated with quality, burden of illness, cost,
etc.

Wide-ranging price variation substantially contributes to the high cost of
healthcare.

Price transparency would result in a narrower price range, with more
services being priced near the median price.

Price transparency would help to decrease waste (administrative,
unnecessary services, etc.) within the healthcare system.

“Price transparency provides consumers with the information they
need to be more fully engaged in their healthcare decision making and
to make financially prudent healthcare choices. The hope is that price
transparency will ignite a transformational trend in care delivery that
will reshape the process and lead to lower costs. However solutions are
rarely as straightforward as they may appear initially and healthcare
price transparency is no exception.”

“Whether it be a high-deductible, consumer-directed health plan or a
more traditional design, consumers need strong economic incentives
to select affordable care options. History tells us the majority simply
will not concern themselves with the prices charged to their insurance
providers.”

“Providing balanced information to make decisions is key. Consumer
trust is low and providing information on price without addressing
quality can raise concerns about the intent. Consumers value
information on convenience, such as location, office hours, and
languages spoken. Integrating this information in one place provides the
context necessary to make informed decisions.”

“Costs can vary significantly depending on where services are
performed (physician’s office, hospital, or outpatient facility). As a
healthcare patient, it can be surprising to receive multiple bills for
a healthcare service — a professional bill, a facility bill, a bill for a
diagnostic test, a bill for an anesthesiologist, and so on. For price
transparency to be of maximum benefit to the consumer, it is vital that
the total costs associated with a particular service or treatment, as
well as how they vary based on where a provider practices, are clearly
illustrated since consumers often have a choice.”

“To ensure consumers understand how they can control or impact
costs, it’s important to convey options, such as the pros and cons of
various care settings, treatments, and provider choices. Patients need
to be alerted to the potential for certain procedures not to be covered
(cosmetic or elective surgery), statistics on the effectiveness of certain

procedures, and whether they will be liable for any expense not covered
by insurance.”

“Dr. Sharon B. Arnold, vice president of Academy Health and director
of The Robert Wood John’s Changes in Health Care Financing and
Organization Initiative, wrote, ‘… when consumers are armed with
the right information, they will demand high-quality services from
their providers, choose treatment options wisely, and become active
participants and self-managers of their own health and healthcare.’”

From Reinhardt, Uwe E., “The Pricing Of U.S. Hospital Services: Chaos Behind A
Veil Of Secrecy.” Health Affairs, volume 35, number 1 (January 2006):

o

“The central idea of consumer-directed care is that the high degree of
cost sharing will force patients to take a more active interest than they
hitherto have had in the cost-effectiveness of their care. This ‘consumer
empowerment,’ as it is sometimes called, can only occur, however,
if prospective patients actually have easy access to user-friendly,
reliable information on at least three dimensions of their care: the
prices charged by competing providers of health care; the costliness of
practices styles adopted by these various providers – that is, the prices
times the quantities of services and supplies they package into the
treatments they render; and the quality of these providers’ services.”

“Report: About 30 cents of every health care dollar wasted; US can cut
costs without rationing”, Associated Press. The Washington Post Co.
(September 6, 2012).

o

Research from the Institute of Medicine found that the U.S.
healthcare system wastes roughly $750 billion each year. The
Institute broke such waste down into categories, including: $210
billion in unnecessary services; $130 billion in inefficient delivery
of care; $190 billion in excess administrative costs; $105 billion in
inflated prices; $55 billion in prevention failures; and $75 billion in
fraud.

o Gusland, Cory, et al., “Consumer-Driven Health Plan Effectiveness Case
Study: State of Indiana,” Mercer (May 20, 2010).

A study by Mercer found that Indiana’s consumer-driven health
care plans, which promote consumer engagement, saved 10.7%
in costs each year in comparison to the state’s PPO plan. Mercer
found such savings were the result of: increased consumer
accountability and responsibility; increased knowledge of
healthcare options, costs and quality; increased awareness of
personal health status; and increased dialogue with doctors

and discussion of alternatives. Mercer also found that such
consumerism could reach its full potential though patient access
to transparent cost and quality information.

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