Blog | Wednesday, December 12, 2012

Update on health care reform


If a patient asks me "How much is this visit going to cost?" the only honest answer is, "I have no way of knowing." How can a patient plan for the coast of the visit? How can the practice as a business work on guesses?

It's just the way we as a nation have decided on. If I charge, say, $90 for a visit, the patient's insurance company may have contracted with me to have the visit discounted to $60. Then the patient may or may not have met their deductible or their out of pocket. They may or may not have money left in their health savings account.

Shopping around for a good price doesn't work all that well either. Prices tend to be set at the level of the insurance company. And do you really want to see the doctor with the best deals?

But let's say you have an unusual medical problem and you want to visit a bevy of specialists. Most people would rely on their primary care doc to coordinate this, but some folks will go off on their own based on their own research. Because different medical systems and different offices use different record keeping systems, each doc has no idea what the last one did.

Frequently, a patient will come to me with a folder full of results, many of which duplicate tests I've already done. Even emergency departments rarely contact the patient's doctor to see what's been done recently. Services are regularly duplicated.

The government has been pushing for the adoption of electronic medical records (EMRs), paying incentives, but eventually collecting penalties for offices that stick with pen and paper. There are a lot of pluses to EMRs, but prevention of redundant services isn't yet one of them.

You see, my office may choose one company, the nearby hospital another, and none of these systems talk to each other. There's a lot of competition in the EMR marketplace, which is good, but it means that one of EMRs most important features, improving communication between providers and preventing duplicate services, isn't going to happen.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.