Patients as customers?

Here we go again--is it the chicken or the egg?  Or, is it the cart before the horse?  Or, will doctors' offices get their acts together and learn to treat patients like hotel guests before those patients drop their HMO's for HSA's?  Elisa's got some valid points at Healthy Concerns--but we all need to take a deep breath. 

For over 20 years now, HMO's have led everyone to believe that everything's covered all the time, and it'll only cost you $5 co-pay.  Well, those days are over.  Now that you're paying $8k/year to insure your family, you're probably going to believe the promises of "consumer-driven health plans" to save you $$ and "right-size" your health budget.

Not so fast.  You know the arguments against price-fixing that apply to the rest of the business world (like, don't cap the price of oil, because we did that in the 70's and the oil companies didn't expand and innovate, and now look where we are)?  Well, your doctors been operating under fixed prices for decades--Medicare, HMO's, PPO's, etc...have told us what we'll be paid regardless of the level of service we provide.  Guess what happened.

Under the payors' fixed-prices, your doctors don't have the capital, the drive, the intellectual resources, the managerial expertise, whatever else it takes to zoom into customer-service overdrive and satisfy your every whim. 

Now, I'm a fan of consumer-driven health plans, personal responsibility and HSA's.  But be patient while your doctor re-tools his production line to respond to these new market forces. 

Kevin, MD found a pie-chart that says policyholders would rather trust their insurance companies than their common sense--check it out, as well as the commentary.

Where should we start?

Comments

[Elisa Camahort]

It's a straw man argument when you shoot down the notion of treating patients like hotel guests. As if that's what we are asking for.

I believe the single specific request I made in my post cited above was that I be called if the doctor had had to leave for an emergency and wouldn't even be there, or if the doctor was running significantly behind.

That's it.

If you think that's my every whim you don't give me enough credit for thinking big :)

[Stephanie]

Hoo-boy....you are absolutely right that doctor's offices should inform patients if there's been a significant disruption in the schedule. It's common courtesy and respectful of everyone's time. I know how my office handles the problem (we call patients), but I fear that some of my colleagues just don't get it.

The point of my post was that most medical practices have a loooooong way to go before they can deliver the level of service implied by CDHP's. We've been operating under price-fixing for so long that it will a major retooling to shift the culture.

Bring on the HSA's, but don't believe their hype that your doctor's offices will be able to accommodate this innovative thinking right away.

With that said--I'm eager to innovate. How should I prioritize my office systems to meet the new demand?

[hgstern]

Dr Stephanie:

I'm not sure that I see the dilemna. If one assumes that the negotiated (contracted) rate is the same whether it's paid by the insurer or the patient, then what's the challenge?

Seems to me that the process wouldn't change; that is, the patient receives the service, and the bill is submitted to the insurer for adjudication (same as now). It's really no different than any other patient that doesn't have a co-pay plan.

The variable here is that the insured is now playing with his own money, and will expect some time with the physician to discuss treatment options and alternatives. I would think that would be something physicians welcome: we've been told for years to take ownership of our own health.

What am I missing?

[Stephanie]

hg--You're not missing anything--but you're speaking as someone who's willing/able to take ownership of your health. Let me tell you, most patients are not the well-educated, well-informed, resourceful bleeding-edgers of the blogosphere. 50% of US adults are marginally-literate, according to the NALS: http://www.nifl.gov/nifl/facts/NALS.html .

Again, the point of my post was to caution the public against believing the hype these CDHP vendors are promising for 2006. Remember, these are the same folks who've promised us "managed care" for the last few decades. They may be peddling new insurance products, but reality will take a while to catch up.

"Under the payors' fixed-prices, your doctors don't have the capital, the drive, the intellectual resources, the managerial expertise, whatever else it takes to zoom into customer-service overdrive." Just be patient with us.

I guess I don't know what it's like for a "patient that doesn't have a co-pay plan." My town is 80+% managed-care penetration, and the rest of my patients are worker's comp! This is going to by a real transition for my local colleagues and me.

With that said--I'm eager to innovate. How should I prioritize my office systems to meet the new demand?