Consumer driven healthcare?

Earlier this week, I received the following letter from an amazing heart-centered nurse (and former host of the #1 show on the FBRN radio network “The Chatterbox with Ellen Hedger”).

And with Ellen’s permission, I share with all of you for your thoughts and feedback …

170831 Ellenred (1)

Hi Tom!

I wanted to share with you an experience I had at my physician’s office right before my scheduled surgery in July.

When I arrived to check in for my pre-operative office visit, the young lady behind the glass window requested my 20% co-pay. This was before I had seen the doctor to discuss the surgical options/prognosis, you know the patient-doctor Q&A of it. This was before she even slid the glass window open.

So I motioned for her to slide the window open, which she did and told her that I was not prepared to part with my $650 just quite yet. I wanted to talk with the doctor, FIRST, about the exact reason my appointment.

When I took my seat, it really hit me. I mean, in what other scenario do you pay before services are rendered? You go out to eat … you get the check after the meal. You buy something at the mall … you pay after you decide you can’t live without it. In fact, you even have the “escape “of returning an item after purchase when buyer’s remorse sets in. Even on a large purchase, a standard contract gives you up to 72 hours to cancel.

I know movie theaters and amusement parks are different, but again, if the experience is dreadful, there is the avenue of complaining for re-compensation (and I have been known to ask for my money back a few times on terrible movies … did you ever see Cry Baby? I should have received double my ticket price back for that one!).

Anyway, so it got me to wondering …

Do I have the opportunity for a money back guarantee when it comes to surgery?

How would we do this?

High pain level after procedure? That should knock off about 10%.

Infection? That’s a solid 20% plus cost of antibiotic.

Scar a bit bigger than expected? That’s worth something. How about three month check in?

Unhappy with results? Is that enough to request a refund?

As a healthcare provider, I am fully aware of the financial side. As a healthcare provider, I mostly concentrate on the CARE side. As a patient (consumer) I have to be keenly aware of BOTH sides.

I feel that there is still a great disconnect in many practices with this.

As it turns out, my doctor changed the game plan for my surgery-decided to go a different route with the procedure. I was comfortable with the explanation for his reasoning and had all of my questions answered. Turns out the procedure was less invasive and guess what-cost less. So the day before surgery, the doctor’s office had to get approval on an entirely different procedure and my out of pocket cost to the physician went down over $100.

Guess who headed to the mall with that extra $$ once recuperated?

Regina Herzlinger, in her terrific book Market-Driven Health Care presents a compelling vision of an evolving healthcare system refocused on meeting the needs of the consumer (aka consumer-driven health care).

And yet the purchase of French Fries at McDonald’s when one has a craving and the ability to seek a refund for poor quality, is vastly different than a petrified parent seeking care for her terminally ill child … or even a savvy healthcare professional seeking information before committing to a financial outlay prior to surgery.

That said …

Yes, Ellen, there are some system’s beginning to offer money back guarantees. Geisinger Health System for example began to do so a couple of years ago in a pilot effort in late 2015 for high copay procedures.

But far too few.

Many systems also have intention to …

  • Provide patient-centered care
  • Engage patients and families proactively
  • Create a highly engaged workforce
  • Evolve Patient Centered Care models to Relationship Centered Care aka Relationship Based Care models
  • and more

… and are on the pathway to get there.

Same with consumer-driven models and money back guarantees.

Ellen, we clearly have a ways to go. And I am so pleased you are part of the solution. Keep leading the way in all you do.

And for the healthcare leaders out there … as you seek to innovate and meet consumer needs … please do not forget the patient and family in the process. Just like with technology, consumer driven health care is sexy. It is also one of the latest flavors of the month. And when implemented both mindfully and heartfully (with the patient and family in mind) can have a positive impact.

Let’s learn from our mistakes and follow our hearts as much as we follow the money. People’s lives are at stake. The lives of those you and I love are at stake.

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