Is there such a thing as too much when you’re sick?
I recently read an article written by Lisa Rosenbaum, MD in the New Yorker called The Problem with Knowing How Much Your Health Care Costs. She used her own experience of delaying medical treatment as an example of how cost can impact a patient’s decision to seek care. The examples used that reportedly affected her decision seemed like exceptions rather than the norm in healthcare finance, but the issue she highlighted is real. Cost information may deter some people from seeking care especially in the absence of reliable information.
Providing an estimated cost in advance of care to patients is nothing new to me and something that I have been working with facilities to do for more than 10 years. It is not as easy as some may think for complex services such as broken bones because there is usually more than one provider involved. In the case of some Emergency Room (ER) services, the issue is even more complex because of the nature of the service. However, given my own ER experience the issues seem to point to a bigger issue than cost alone.
Too Much Knowledge
Like Lisa, I was lucky to have had health insurance and a healthcare savings account when I experienced stomach pain so severe that I ended up in the emergency room. I knew something was really wrong as I left a lunch meeting because I recognized the pain. Something had ruptured – but what? I called my mom who was a nurse and knows my medical history better than anyone to ask whether or not to go directly to an ER.
Cost weighed on my mind in the moment but there was something else too. In the industry, we often talk about the high cost of care in ERs and how much of that care can be delivered in lower cost settings. It was the second part of that statement that left me wondering whether my condition was serious enough to warrant an ER visit. After conferring with my mom, I went home to see if the pain would pass.
Both Lisa and I attempted to triage our care in a similar way which makes me wonder… how does an average American decide whether or not to use an ER when they are sick or in pain? Does everyone try to triage their own care or should there be some more formalized way to help triage care?
Too Much Care
By the time, I got home it was clear that the pain wasn’t going to pass. A friend took me to the closest ER and stayed with me through all of the testing. I’ll spare you all the details but there was one notable difference from the process used to diagnose my appendicitis. My care this time started with something my physician described as one of the meanest things they do to patients [NG Tube] followed by a CT scan rather than a physical exam. When the images didn’t reveal the problem, the physician did a physical exam which revealed the location of the pain and a probable diagnosis.
The next day, I saw a specialist who did a physical exam and then ordered an ultrasound. Something had ruptured but fortunately, nothing that needed further medical treatment. While it was good news especially in light of the initial diagnosis, the whole experience was still upsetting. During the ultrasound the technician mentioned that she was on call for the ER but wasn’t called.
I couldn’t help but wonder whether the ER visit was all for not. Could the ER physician saved time and money by starting with a physical exam or was, as my friend described it, his “process of elimination” necessary given the nature of the issue and/or lack of medical information about me?
Too Much Money
The bill for the ER visit was more than I expected and my portion was also more than I expected. The out-of-pocket maximum on my health plan was more than my deductible and the maximum annual HSA contribution. I paid the bill but it didn’t feel right given the misdiagnosis, the testing that may or may not have been needed and the stress of it all.
Admittedly, when you are really sick or in pain, there is no such thing as too much money – cost becomes irrelevant and more care somehow seems better. However, after the fact is another story especially if the value of the care received isn’t clear. Billing clerks, for the most part, can say what was done when but few, if any, can explain why. Connecting the dots between what and why without a medical degree and/or understanding someone’s thought process in the moment is almost impossible.
The only one that can truly connect all the dots needed to understand the value is the physician providing the service. That’s why I have to wonder …should physicians be connecting the dots (what, why and how much) for patients who are stable?
Safe to Say
There is always more to an issue than what meets the eye or what can be learned from an experience or two. However, it seems like there is opportunity to enhance the way patients are triaged and informed during the treatment process to help connect the dots between cost and care so that the value of the care provided is clear.
It’s just human nature to take time to connect the dots. But I also know there can be a day of reckoning, when you wish you had connected the dots more quickly. -Al Gore
