Well said, Dr. Centor:
Both government run single payer systems and our current insurance system have a common serious problem In both systems, the patient has no financial investment in decision making. Taking financial decision making away from patients leads them to want more, regardless of true value. Patients want CT scans for everything. They want the fancy DTC advertised drugs. They want to see a subspecialist whether that subspecialist would likely help them or not.
I’m not saying that patients should completely be consumers, which they are not equipped to do in hospitalized or emergency settings.
But having the patient bear some financial responsibility in non-urgent conditions is essential going forward. Specifically, cases where patients desire care above and beyond what is needed.
Wanting an MRI when a physician deems it unnecessary, or insisting on brand name medications when generics are appropriate for instance.
topics: single payer, health care reform
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I like that concept. If a physician orders a test solely because the patient demands it, a special ICD-9 code should be used to reflect the fact that the order was not based on medical necessity and the patient is responsible for payment.
We already have something similar to this in the DME industry. It’s not a special ICD-9, but rather a modifier that’s attached to the billing code for the item HCPC (CPT for practitioners), which indicates the DME was not ordered by a physician, or other licensed practitioner. Some items we carry can’t be dispensed without a prescription, but many don’t require one, unless the consumer wants their insurance billed for the service. However, in general, if we receive a prescription for DME, that’s telling us the prescriber deems it to be medically necessary. If practitioners feel that some procedures are unwarranted, they shouldn’t prescribe them. However if a patient wants say a CT scan that’s not necessary they should pay up front, or make payment arrangements, if that’s possible without a script.
Deron: and how many time will the average physician experience verbal abuse, formal complaints, and even threats before he stops using that code forever?
BTW, aren’t MRI’s therapeutic? As long as the physicians are also selling himself to the patient as a customer, they aren’t not going to go against them to any great degree. I have seen too many people want an MRI they didn’t need–they will always get it from someone even if they have to shop around, and forever deride the professional skills of the doctor who wouldn’t order it.
What is needed is for people to pay for their own non-castatrophic health care without third party intermediaries.
Not only should the patient bear more of the cost of their treatment, but the entire system should be more transparent so consumers know who’s getting what and why. The government (At all levels) and insurance companies have their fingers so deep in the healthcare pie a consumer can’t hope to make an informed choice with cost as a factor.
We, as patients, have been told incessantly to take charge of our own healthcare. It’s easier than ever nowadays for an individual to keep up on their own illnesses and treatments and know more than the doctor that’s treating them. What we need now is the next piece of the puzzle: the ability to see what everything costs and how the money flows in the system.
And if a patient wants a test that a doctor doesn’t think is necessary and is willing to shoulder the financial burden, why should the patient be able to?
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