Jeffrey R. Carlson, MD

As physicians, we are concerned about the physical and emotional well-being of our patients. We work to diagnose illness and provide treatment solutions that will bring about positive results. However, there is another aspect of patient treatment that deserves our attention: the fiscal well-being of our patients.

With the rising costs of health care now being passed along to the consumer, patients are seeing their healthcare expenses skyrocket.  For those who must pay for insurance either partially or entirely, a family of four can easily spend more than $1,000 a month just to get basic health insurance.  Most have seen copayments double or even triple. Many annual deductibles are now over $5,000, and out-of-pocket expenses are going through the roof.

An unintended consequence of the Affordable Health Care Act is that families are having to weigh the cost of having insurance against the cost of housing, food and other necessities.  If a surgery will cost them, out-of-pocket, more than three months wages, how likely is it that surgery will be delayed or cancelled altogether?  Having to pay a copayment or coinsurance could mean that the family can’t afford their electric bill or groceries.

As physicians, do we work to ensure that the services we prescribe are in the best financial interest of those for whom we provide care?  We need to add another factor when thinking about our treatment options, where we also engage our patients regarding how the care we recommend will financially impact them.

Consider the MRI scan, a highly useful diagnostic imaging resource.  The difference in payments to hospitals vs. free-standing MRI providers for this service is astounding, usually totaling thousands of dollars.  With this shift to higher deductibles, the out-of-pocket cost to the patient can be enormous as well!

Consider the recent case of a patient who wanted to have her MRI scan at a free-standing clinic.  She was informed (by the insurance company) that the clinic was out-of-network and that she would have to access MRI services at a local hospital, which her insurance company assured her was in-network.  She followed the recommendation of her insurance company, assuming that she would receive the maximum coverage.  Imagine her dismay when she received her bill and learned that her out-of-pocket responsibility for the MRI was $1,800, even when going to an in-network MRI provider.  She felt cheated and was angry because no one told her she had any options.

How could this scenario have played out differently?  Her physician could have told her to compare prices and even to consider going out-of-network or self-pay for her MRI.  Why?  Because most free-standing MRI clinics charge an average of $700 – $1,000 for a self-pay MRI scan, and less for an out-of-network scan.  The cost savings for the patient would have been significant and their satisfaction during this encounter could have been greatly improved.

Physicians do not often see financial issues to be a consideration when treating most patients’ acute illnesses.  However, our patients would be more content with their overall healthcare experience and much better served if we started to do so.

Jeffrey R. Carlson, MD is the President and Managing Partner of Orthopaedic & Spine Center in Newport News, VA. He holds a fellowship in Orthopaedic Trauma surgery and a combined Neurosurgery-Orthopaedic fellowship in complex spine surgery from Brigham and Women’s Hospital in Boston.  osc-ortho.com