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https://www.eurekalert.org/pub_releases/2017-03/s-wtr030617.php
More than three in every five Americans see a doctor who receives some form of payment from industry. This is according to a new survey led by Genevieve Pham-Kanter of Drexel University's Dornsife School of Public Health in the US. It is the first nationally representative study to examine the prevalence of industry payments among the general population of patients.
[...] The survey was done in light of the Patient Protection and Affordable Care Act, which addresses concerns that industry payments could lead physicians to make decisions that are not in the best interest of their patients. Since 2013 the Act requires pharmaceutical and medical device manufacturers to report gifts and payments they make to healthcare providers. This information is publicly available on the Centers for Medicare and Medicaid Services' Open Payments website.
[...] The survey highlighted that 65 percent of respondents had visited a physician who accepted an industry payment. This was particularly the case for those visiting family medicine physicians (63 percent) and obstetricians and gynecologists (77 percent).
The Open Payments website can be found at: https://www.cms.gov/OpenPayments/index.html
References:
Pham-Kanter, G. , Mello, M., Lehmann, L., Campbell, E., Carpenter, D. (2017). Public Awareness of and Contact with Physicians Who Receive Industry Payments: A National Survey, Journal of General Internal Medicine, DOI: 10.1007/s11606-017-4012-3
(Score: 2) by fishybell on Wednesday March 08 2017, @05:48PM (1 child)
This to me is the biggest problem. They can't tell you how much a service will cost until they try to bill your insurance? Really? Of course costs are high when every time they try to squeeze as much money as possible and see what the insurance will accept.
If you can't shop around for a cheaper alternative, how is anyone's rate supposed to go down, ever?
(Score: 3, Interesting) by AthanasiusKircher on Wednesday March 08 2017, @09:27PM
They can't tell you how much a service will cost until they try to bill your insurance? Really? Of course costs are high when every time they try to squeeze as much money as possible and see what the insurance will accept.
Yes, I completely agree -- this is preposterous. Frankly, I think every doctor's office should be required to post a list of fees for standard services. "Sick visit - $X, Physical - $Y" and amounts for add-ons with in-office care. If they do blood tests or urine tests or whatever in-house, I should know what they will charge me before I take the test. If they add on a fee for ECG or some other machine, I should be able to tell what that's going to be. If I go to a hospital for an out-patient procedure, same thing. Yes, they could list a fee range for unpredictable things that can occur during a procedure, but unless you're undergoing majority surgery that could have a multitude of complications, it should be reasonable to give you an estimate.
As for insurance "discounts," this could also be easily standardized. Basically, what they're doing is offering a group discount anyway -- they could just make it easy and just have a standard percentage discount, like just about every other business on the planet. "Oh, you're in-network, well, you get a 15% discount on all services in our office." Done. Period. End of story. Easy to calculate. A doctor's office wants to exempt services from the discount? Fine -- again, put it on the public posting of fees: "Group insurance discounts don't apply to posted fees for ECG and blood tests other than standard lipid panels done for a physical" or whatever. Done.
For people who pay out of pocket or who haven't satisfied a deductible, this should all be clear. It's a little harder to solve the problem of whether a procedure is "covered" by insurance, but that again should be something very easy to find out. You get the estimate from your doctor's office, and it has some billing code numbers, you go to your insurance website, type in those code numbers, and it should pop up whether the procedure is covered or not.
The biggest thing with all of this is that it would likely make healthcare immediately cheaper, even BEFORE any benefits from a better market where consumers can shop around. Why? Because insurance negotiation of fees and billing crap is a HUGE overheard cost. Somebody at the insurance company has to negotiate all those details of fees with a doctor's office or medical group or hospital, and those frequently get renegotiated. Then your doctor's office needs to file claims, then the insurance company has to process them, then errors get made by someone, and things get refiled... perhaps the doctor's office has to negotiate whether something is covered, etc., etc.
It's just way too complicated. With a required estimate and verifiable coverage up-front, probably 80% of all those negotiations can be avoided, saving staff time at the office/hospital and for the insurer, and thus saving you a lot of money. You also avoid the nonsense of having to resolve billing errors after the fact, which is always a bad idea because nobody's interested in helping the customer at that point. For larger or more questionable procedures from a coverage standpoint, if you have the estimate in hand, you check it over yourself, and sign it to accept that you're willing to pay up to that amount. If you have a problem with the estimate, you resolve it up-front or simply go find another doctor. Everything is streamlined.