Healthcare Consumer Survey Results: 70% Look Up Symptoms; 40% Look up Cost/Quality

The Altarum Institute conducts a semi-annual healthcare consumer survey.  Below are some statistics from their most recent Spring 2014 survey of 2,099 healthcare consumers:

  • 90% of healthcare consumers want to be in control of medical decisions or share decision making with their doctors.  Only 7% want the doctor to be in control.
  • As the title reads, 70% of healthcare consumers look up symptoms online before going to the doctor.  However, only 40% look up cost or quality information regarding healthcare.
  • Word-of-mouth is still the leading source of recommendations for healthcare providers—72% of healthcare consumers rely on it.
  • 90% of healthcare consumers are concerned about healthcare bills and costs.  80% say they would feel comfortable talking to their doctor about costs.  However, only 50% of healthcare consumers have ever asked their doctor about costs.

Read the full Altarum Institute Survey of Consumer Health Care Opinions by clicking here.

What do these statistics mean for employee benefits professionals and healthcare consumers?

(1)   Employees and their family members want to be in control of their healthcare decisions.  (2) They are concerned about costs.  (3) They want to talk to their doctor about costs, but… (4) only about ½ do.

So their seems to be this gap between desire and action.  That’s ok.  Being a healthcare consumer and consumerism is a paradigm shift and a cultural change and these things take time.  Before any change in behavior happens, there needs to be a change in thinking.  This Altarum survey, in my opinion, shows that the thinking is there and the behavior is slowly staring to change.  It will take time, but the movement from consumerism-thoughts to consumerism-actions is gaining momentum.

At Compass, we help employers accelerate that culture change through tools and support for healthcare consumers.  Click on the link below to watch a 5-minute video by me that discusses how Compass does that.

Top 3 Errors Made by Consumers When Receiving a Screening Colonoscopy

Not necessarily a fun thing to think about—but when most people turn 50 it is time for them to go and have a colonoscopy to screen for polyps and colon cancer.  There are 3 very common errors that we see at Compass as it relates to consumer understanding of the billing related to a screening colonoscopy.

Error #1 – The colonoscopy is screening and therefore will be paid for at 100%.

 This is an error, because depending on what is found during the colonoscopy and how the colonoscopy is billed, it could be classified as a ‘Diagnostic Colonoscopy’ and therefore, be subject to deductible and coinsurance.  Now some self-funded employers have written their plan documents such that even the diagnostic colonoscopies are covered at 100%, but across our hundreds of thousands of members at Compass, that is a rarity.  Almost all full-insured plans in our experience have diagnostic colonoscopies fall to deductible and coinsurance.

Therefore, it is important to understand before your screening colonoscopy, that if the doctor finds a polyp or some other lesion during the procedure, that it is likely that the colonoscopy will be billed as diagnostic and that you will usually have to pay some out of pocket cost—which could be upwards of $4,000, but we’ll get to that later on in the post.

Error #2 – I want to be ‘knocked out,’ but not knowing if it is the gastroenterologist or an anesthesiologist performing the sedation.

This is an error, because the ‘conscious sedation’ for the procedure can be performed by either the gastroenterologist (GI doctor that performs the colonoscopy) or a separate anesthesiologist.  If the gastroenterologist performs the conscious sedation, then usually you will not receive an additional bill strictly for the sedation.

However, if a separate anesthesiologist performs the conscious sedation, then you MAY receive a separate bill from the anesthesiologist for the sedation—especially (as described above) if the colonoscopy is not billed as preventive, but rather as diagnostic and therefore subject to deductible and coinsurance.  That additional anesthesia bill may be upwards of $800.

The important point here is that most gastroenterologists perform their own conscious sedation for the majority of their colonoscopies and with these physicians performing your procedure, you will not run the risk of the additional bill.  However, there are some gastroenterologists who routinely use a separate anesthesiologist to perform the sedation during the procedure.

So how do you know the difference?

You need to ask the gastroenterologists office.  They will likely know the answer and will be able to tell you, “if you are not a high-risk patient for sedation, then Dr. So-and-So, the gastroenterologist, will perform the sedation and there will be no additional bill.”

Error #3 – Not realizing that where you schedule your colonoscopy will potentially change your cost.

This is an error because the facility fees are very different depending on which hospital, endoscopy center or ambulatory surgery center you go to.  Some facilities cost over $4,000.  Others cost $500.  I will discuss in a future blog post why this price differential exists, but it is not necessarily because of an objective quality different among the facilities.  In fact, often the same gastroenterologist will perform colonoscopies at different facilities depending on what day of the week it is.  For example, he may perform procedures at the hospital on Mondays, where the facility fee is $3,800 and at the ambulatory surgery center on Tuesday, where the facility fee is $800.

This fee difference is important—again—because if your colonoscopy is billed as diagnostic, you may have to pay some or all of that cost yourself and that fee difference will affect your out-of-pocket cost.

So if you like your gastroenterologist and you do not want to change doctors, ask the doctor’s office staff if he or she performs procedures at different facilities and if he or she does, then contact the facilities to find out what their colonoscopy fee is—more on how to ask facilities for their fees in a later post as well.

Confused?  Don’t worry, most people are.  I hope this has at least helped a little to explain some of the nuances around colonoscopy bills and paperwork.  What do you think?  What are some challenges around medical bills that you have encountered?

Click below to view the Compass Overview YouTube video:

4 Questions That Will Help You Find the Right Physician

Finding a good physician is one of the greatest challenges for a healthcare consumer. It is also one of the most important choices a person makes when it comes to their medical care.  It is so important because, in my opinion, there is actually quite a bit of variability and subjectivity in medicine.  How you are diagnosed and how you are treated will vary greatly among physicians, which is why if you ever find yourself saying things like “I’m just not getting better” or “What the doctor said just didn’t make sense” or “Is that test/procedure/prescription really the right thing”—You should seek a second opinion.  Second opinions are good things.  Any physician worth his or her salt will not be offended if you seek a second opinion.

But how do you find a good physician in the first place?  The best approach may not seem as obvious as you think:

Call the doctor’s office and ask the following questions:

(1)    Is the doctor taking new patients?

(2)    Does the doctor see patients for _________ (insert your medical issue here: pain, check-up, rash, etc.)?

(3)    When is the first available new patient appointment?

(4)    Can you describe the doctor’s bedside manner?

You want to ask these questions for several reasons.  First, there are some basic, logistical answers you need to obtain.  Often doctors (especially good doctors) are not taking new patients, so you need to get that one out of the way up front.

Second, you cannot assume that the doctor will automatically see patients with your type of medical concern—you need to expressly ask.  For example, if you are interested in starting a family, you need to specifically ask an Ob/Gyn if she still delivers babies—not all of them do.

Third, getting an appointment may be 6 – 8 weeks in the future. If that is just too long for you, you need to know that up front so you can contact someone else.

Finally, most physician practices are small (only 1 or 2 doctors) so all the staff interacts frequently with the doctor and they know how they treat their patients.  Ask about their bedside manner.  Surprisingly, most of the time they will tell you the truth, and it is not always good.

What are some common red flags you need to look out for?

  • “Well, the doctor is very busy”: Translation-rushed.  All doctors are busy.  That is never an excuse to come across that way.
  • “Well, the doctor is very focused”: Translation- cold, impersonal. All doctors went into medicine because they want to help people and helping people means treating them with courtesy and establishing what is referred to as a therapeutic relationship.  Some doctors have lost interest.  The joy is gone.  The flame is out.  They become cold and distant.  Stay away!

There are also some positive comments you should search for.

  • “The doctor spends a lot of time with her patients”: Translation: meticulous, diligent, detail oriented.  Diligence is the top quality you want to find in a physician and the best way for that diligence to manifest itself is with time.  All of the best doctors I knew at Johns Hopkins took their time with patients.  I never witnessed a good doctor rush with his or her patients.

Also, if a doctor takes time with their patients, they likely also take the time to read and stay up to date.  Constant reading and learning is the hallmark of a great physician.  All physicians know this and you want a physician who takes the time to do it.  I knew a vascular surgeon at the University Of Illinois College Of Medicine who read two hours every night.  There was another general internist at the same College of Medicine that read the entire 1,800 page textbook on medicine every year.  On January 1st, he would start on page one and he would finish by December, repeating the process over on the January 1st of the next year.  Not surprisingly, he said he learned something new every time he read it.

  • “Doctor _____’s patients just love him”: Translation: the doctor is warm and caring.  Establishing a therapeutic relationship with a patient is vital—it literally helps the patient get better.  In my opinion, part of the reason for this is that where there is caring, there is better communication. Better communication leads to an accurate diagnosis and an accurate diagnosis leads to the correct treatment.

Another key reason why the above four questions are so important is that the WAY the office staff answers these questions is a good indication of the doctor’s ability and personality.  If the doctor is good, they will likely attract good employees.  If the doctor treats his patients well, they will likely treat their staff well—and the staff accordingly, will speak fondly of them.  If the doctor is diligent (there’s that key trait again), they will not tolerate rude or incompetent employees and will replace them.

So when you ask the above four questions, if the staff is rude, cold or impersonal—find another doctor.  If the staff is rushed and seems too busy to answer your questions—find another doctor.  If the staff is so thrown by your bedside manner question that they seem offended or turned off (yes, this does happen)—find another doctor.

Compass has phone screened hundreds of thousands of physicians so our members do not need to call the doctor’s office—we have done that for them.  However, regardless of if you have Compass as your personal healthcare advocate or not, the above approach will help you find the right doctor to lead you on the path towards good health.

What do you think?  What have you done in the past to find a good doctor?  What traits about a physician have turned you off in the past?

Below is a link to a 5-min video of me speaking about my company–Compass Professional Health Services.  Compass works with over 1,700 employer clients to make their employees better healthcare consumers through price-transparency and provider quality comparisons delivered through a personal healthcare concierge who will review and resolve problem medical bills and search out great physicians that meet the specific needs of each of our members.  Thank you for reading this blog post!

Incentive Best Practices for Employer Health Plans—Stanford Professor’s Framework on Behavior Modification

In order for employees and their family members to obtain higher quality care at lower cost—they need to change their behavior.

As Albert Einstein said, “The definition of insanity is doing the same thing and expecting different results.”  If employers and employees want more value—higher quality, lower cost—for their healthcare dollars, they need to do something different.  Whether that is: be more compliant with their medication regimens, get their age appropriate screenings, compare cost and quality when choosing a doctor or hospital, come prepared for office visits, use more generic medications where appropriate, lose weight or stop smoking.

The doctors, hospitals, government, pharmaceutical companies and insurance carriers may need to change their behavior too, but they are not as ‘impactable’ as an employer’s own employees.

Stanford Professor, Dr. BJ Fogg, has laid out an elegantly simple framework for behavior modification that directly applies to incentive best practices for employer health plans.  The professor’s framework has three parts.

  1. Motivation—the benefit that comes from the change in behavior.  That could be a dollar reward, avoidance of a financial penalty, personal recognition, better health, etc.
  2. Ability—the skill to perform the desired behavior.  This involves teaching, coaching and directly assisting the individual.  Essentially, “Show me how to do what you want me to do and help me do it.”
  3. Trigger—the reinforcement of #1 and #2.  Remind me of the benefit.  Explain to me again how I am supposed to do what you want me to do.  Repeat.  Again.

Interestingly, the professor states that if you are not achieving your behavior modification goals, the first place you should look is #3—The Triggers.  Are they frequent enough?  Are they reaching the right people?  At the right time?  Are they phrased in different ways through various media—in person, print, audio, video, individually, in groups?

Let me repeat that:  if you are not achieving your behavior modification goals, the first place you should look is The Trigger.

Here is a link to the professor’s site at Stanford for more information and a very good 2-minute video by him (if you scroll down):  BJ Fogg’s Behavior Model

Many employers think they need to increase the dollar amount of their incentive.  Others think they need to increase the severity of the penalty.  Still others think they need to improve the coaching (“it’s not working because our coaches and educators are bad”).  While these may be true, the low handing fruit is the trigger.

As you look to modify your employer health plan in the context of Health Reform and you want your employees to behave differently, think first about your organization’s current triggers and what you can do to improve them.

I have recorded a short 5-min video on best practices in employee engagement from what Compass has learned from supporting over 1,700 employer clients.  Click on the icon below to view the video.

Health Reform: Premium Amount that Defines a ‘Cadillac Plan’

Beginning in 2018, the Federal Government will tax employer health insurance plans that are especially ‘rich.’ These rich plans are also referred to as ‘Cadillac Plans.’ These types of health plans provide many benefits at little to no out-of-pocket cost resulting in premium costs (typically paid by the employer) that are very high.

The definition of a Cadillac Plan is the combined annual premium cost (i.e. paid by employer and employee together) of greater than $10,200 for an individual and greater than $27,500 for a family. See this release by the large labor union SEIU for more details: The Impact of the Excise Tax on High-Cost Health Plans

The types of employees that might have Cadillac Plans are employees that are part of a labor union—which is why the SEIU came out against taxation on Cadillac Plans. Other types of employees that might have Cadillac Plans are executives or those in other highly-compensated positions (e.g. computer programmers, investment bankers, engineers, etc.).

The Congressional Budget Office (CBO) expects the excise tax on Cadillac Plans to generate $10 Billion in taxes in 2018 and steadily increase every year to $35 Billion in 2023. Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage (see page 2).

As employers, unions and broker/benefit consultants plan ahead, they will want to consider changing plan designs in advance of 2018 to avoid the excise tax. A way to make plans ‘Non-Cadillac’ is to increase the out-of-pocket costs paid by the employees. By doing so, the plan will be less rich. However, that cost-shift can be addressed and largely mitigated through concierge services like Compass that enable employees to be smarter, more supported healthcare consumers who are able to receive high quality care at lower cost providers. Compass already has multiple oil and gas clients that have used this strategy. Similarly, other employers may want to start resetting the expectations of their employees sooner rather than later.

Click below to access the Compass Overview YouTube Video:

What Doctors Do When They Make Their Own Doctor’s Appointment

The way that doctors themselves receive medical care and navigate the healthcare system is somewhat different from the way other people do.  Here is one thing many doctors do differently when they make their own doctor’s appointments:

Many doctors try to schedule their own appointment as the first appointment of the day.

There are two main reasons to do this:

  1. The appointment will most likely be on time.  Doctors are notoriously late and they ‘fall behind’ almost every day in their clinic schedule.  The reason: urgent/emergent things with other patients come up that the doctor must attend to, which slows them down, which makes them late for their appointments later in the day.  The later your appointment is scheduled in the day, the more likely it will not be on time.  It may start 30 minutes, 1 hour or even 2 hours after it was scheduled to.  I know a Rheumatologist in Baltimore who ran 2 hours behind schedule almost every afternoon and his patients would wait until 7:00 or 8:00 PM to be seen.
  2. Doctors are mentally ‘fresher’ at the beginning of the day than at the end.  Almost every doctor I know is exhausted and chronically sleep deprived.  If you see a doctor at 9:00 AM for an appointment, it is likely they have been awake since 4:30 AM and started seeing patients at the hospital at 6:00 AM (especially surgeons).  However, at least you saw the doctor when they had only been awake for 4 and a half hours.  If you see the doctor at 4:30 PM, they will have already been awake for 12 hours and seen 30 patients before you.  So you will have the doctor’s best ‘mental effort’ at the beginning of the day rather than at the end of the day.

If your appointment can wait a day or a week so you can schedule it at the beginning of the day, that might be a good idea.

For more information specifically on preparing for an office visit to an Orthopedic Surgeon or Orthopedist (doctor for bones and joints), I created this 5-min video.  It has some critical tips regarding what pitfalls to look out for.

Healthcare Data Analytics: Top 10 Healthcare Claims Cost Categories—by Procedure Type

There are many ways to analyze healthcare claims cost.  One effective way is by procedure type.  Compass analyzes hundreds of millions of claims for employers annually and based on our research, here is a list of the Top 10 Healthcare Claims Cost Categories by Procedure Type (the actual rank will vary by employer):

  1. Labor & Delivery
  2. CT Scans
  3. MRIs
  4. Upper GI Endoscopies (also known as EGDs)
  5. Colonoscopies
  6. Orthopedic Joint Surgery (e.g. arthroscopic surgery, joint replacement)
  7. Spine Surgery (e.g. discectomy, fusions)
  8. Abdominal Surgery (e.g. gallbladder removal, intestinal surgery)
  9. Cardiovascular Surgery and Procedures (such as cardiac catheterizations)
  10. Gynecologic Surgery (e.g. hysterectomy)

Notice that these top 10 cost categories mostly fall into 3 groups: (1) elective surgery, (2) GI procedures, (3) imaging.

To strategically target these cost categories, you can employ value-based benefit design, price-transparency, consumerism and population health management programs.  Other companies have and as a result, they have lowered their trend or even reversed it.

Click below to access to the Compass Overview YouTube Video:

Primary Care Physicians—What Consumers Need to Know

Primary Care Physicians (PCPs) are general medicine doctors for adults and children.  Internal Medicine doctors are PCPs for adults only, Pediatricians are doctors for children and Family Practice doctors are general doctors for both adults and children. Ob/Gyns are typically not considered PCPs for insurance purposes (i.e. usually not a PCP copay, but rather a specialist copay to see an Ob/Gyn).  PCPs see patients for annual checkups and preventive screening (blood pressure, cholesterol blood test, etc).  PCPs also see patients for acute illnesses like upper respiratory infections, chronic conditions like high blood pressure and diabetes and other issues ranging from achy joints to rashes to seasonal allergies.

Here are 3 things that healthcare consumers need to know for a visit to a PCP:

  1. If you are going for a preventive or wellness exam, you need to speak with the physician about coding the visit as a well checkup.  Oftentimes the diagnosis code  V70 is used for such a visit. Under this code, the visit will be covered at 100%–meaning you will not have any out-of-pocket cost.  If you have a specific complaint (e.g. sore throat), either schedule another visit for that issue or just know that your visit may be coded differently and you will therefore need to pay for the cost of the visit (often $80 – $120) or pay your office visit copay (often $20 – $40).
  2. If you have a particular issue–like the ones listed above: achy joint, rash, allergies, even heartburn too—and are not sure what type of doctor to go to, it might be best to see a PCP first.  Often your PCP can diagnose and treat the issue. If they cannot, then they can refer you to the right kind of specialist.  When people ‘self-refer’ to a specialist, they may pick the wrong doctor and then they have wasted time, money (you still have to pay for the appointment for the wrong doctor) and have delayed the right diagnosis and treatment.  For example, a person with low back pain may self-refer to an orthopedist that specializes in knees—orthopedists often sup-specialize and it is somewhat difficult to determine what their area of expertise is.
  3. If you are prescribed a medication for a rash, high blood pressure, diabetes, allergies, etc and that medication is brand name—ask for a generic medication that can also treat that condition instead.  All of these conditions have many generic options that are very effective, cost more than $100 less, and are more well established—so most possible side-effects are known and can be avoided or controlled.  For example, the generic diabetes medication metformin is only $4 and is actually the evidence-based best 1st line medication for diabetes.  It can cause upset stomach in the beginning, but if it is taken with food and taken in small doses to start and then increasing doses over time, then it can be well tolerated.

I have created an easy-to-watch 5-min video version of these hints and tips related to Primary Care Physicians.  Click on the link below to view the video:

Anesthesiologists—What Consumers Need to Know

Anesthesiologists are doctors that specialize in ‘putting patients to sleep’ for surgery or other procedures.  They also administer pain medication and insert epidurals for deliveries.  Some anesthesiologists sub-specialize in what is called ‘Pain Medicine’ where they are experts in treating chronic pain or hard to control pain.  Typically people do not choose their anesthesiologist.  You have a surgery scheduled with a surgeon or a delivery with a certain Ob/Gyn and the hospital just ‘provides an anesthesiologist’ for the procedure or delivery.

Here are 3 things consumers need to know about anesthesiologists:

  1. Because people often don’t have  a choice in their anesthesiologist, many anesthesiologists have chosen not to participate in your insurance network.  So it is very likely that if you are having surgery or a procedure that requires sedation, that you will have to pay out-of-pocket for the anesthesiologist’s charges and have the cost apply to your out-of-network benefits (i.e. a separate deductible, coinsurance and out-of-pocket max from your in-network benefits).  Typical anesthesiologist charges range from $800 – $2,000.
  2. You can talk with the operating room at the hospital, the anesthesia group and/or your surgeon about your concerns about anesthesia charges. There are often lower negotiated prices that you can pay than if you did not contact the hospital, anesthesia group or surgeon in advance.  Potentially the operating room can find an in-network anesthesiologist for your procedure.  Potentially the anesthesia group will accept in-network reimbursement by your insurance company as payment in full.  Potentially your surgeon’s office can coordinate with the anesthesia group to have them accept in-network payment as payment in full.
  3. Anesthesiologists will often require you to have a pre-operative clinic visit prior to an operation for lab tests, potentially an ECG and a chest x-ray.  These pre-operative services may or may not be covered by your insurance, so it is important to check with your insurance carrier prior to your visit.  The collective cost of the visit, lab tests, ECG and x-ray can be upwards of $250.  The anesthesiologist may need to submit special documentation to have the charges covered.

Anesthesia care is often part of a surgical procedure and surgical procedures can vary in price with the same surgeon depending on where he or she performs the surgery.  That difference among price among hospitals and ambulatory surgery centers is part of the reason healthcare price-transparency is so important.

Click on the link below to learn how hospitals and insurance carriers negotiate their contracts to cause these wide variations in healthcare prices.

ER Doctors—What Consumers Need to Know

ER doctors are specialists that are officially referred to as Emergency Medicine Physicians.  ER doctors see patients in the emergency room for acutely serious or life threatening situations like bleeding, fractures, loss of consciousness and inability to breath.  ER doctors also treat many non-serious and non-life threatening conditions such as bladder infections, vomiting and diarrhea.  Of course the challenge is, it is hard to know what is serious and what is not serious.  Often you do not know until you are examined by the ER doctor.

Here are 3 things consumers need to know about ER doctors:

  1. Many insurance policies only cover ER visits or only charge you your ER copay if the care is determined to actually be a true emergency.However, because you do not know if you are really having an emergency or not until you are examined, it is impossible to know beforehand how your ER visit will be covered by your insurance.  Will it only be a $100 copay or will you have to pay the full $4,000 ER charge?  You often cannot know in advance.  The solution is to that if you think you are having an emergency—just go to the ER—and you can sort out the billing afterward.  It may take a matter of weeks or months for the billing issues to be resolved, but through patience and persistence, many ER bills can be appropriately resolved and processed.
  2. You can avoid many ER visits by finding a primary care physician (PCP) that has evening and weekend hours and  an after-hours call in line.  Typically larger, group PCP practices have these types of hours and support over the phone.  Establish care with one of these PCP groups by going in to have your annual physical (it is $0 out-of-pock since preventive care is covered at 100%).  Once you have established care and are one of the ‘doctor’s patients’ then you can call in after hours or be seen for same day or next day appointments if you need to—therefore avoiding the ER.  The key is you have to establish care with the PCP first.  You can’t just be a new patient and call in and expect to be helped the same day or over the phone.  Basically the doctor needs to ‘know you’ first.
  3. If you need to see a physician and it is the night or the weekend and you do not have a PCP, then know where the in-network urgent care centers are in your area.  Many urgent care centers can provide diagnosis and treatment for bladder infections,  vomiting, diarrhea, dehydration and other acute illnesses.  If you go to an urgent care center and they determine that you are truly having a medical emergency, they can always transfer you to an ER or directly admit you to a hospital.  Often times, your urgent care copay will be $50 – $100 and you do not have to worry about the care being covered or not depending on if it is a true emergency.  The trick here is to check in advance which urgent care facilities are in-network and are really true urgent care centers (not just satellite locations of the hospital ER).  If it is a satellite location of a hospital ER, then you will be billed just like you were going to the real ER, so you have essentially not avoided the same billing hazards.  If it is an in-network urgent care clinic, then it is more likely your care will be covered by your insurance regardless.

As medical bills related to ER visits are especially problematic—i.e. incorrect—costing healthcare consumers hundreds or thousands of dollars more than they should, click on the link below to watch a 5-min video by me on how to fix problem medical bills.