Complex and Costly

At this point you may be questioning my image choices. All three of the above images have similar traits. The cost of your journey and the value you get out of your service depends entirely on when and where your journey occurs. The systems that affect these costs are only mildly predictable.

Make no mistake I just called your health a journey. Life is a journey is a common quote I’ve heard in my 40 plus years of life. So just like travelling on a train or a plane, the cost and quality of your journey depends on when and where you travel.

If I want a cheap flight or train trip, I’d book it to depart on a Wednesday at least a month from now. Healthcare works the same way. If you wanted to prevent a high cost hospital stay, you’d catch a progressing disease during your annual physical.

If I want a lower cost flight, there might be another airport I have to connect through. The same is true in healthcare. A provider outside the health system your doctor works for might provide lower cost care.

You see as our healthcare system consolidates, many independent practitioners have become part of larger health systems. They then gain an inherent conflict of interest. I hear it a lot when I advocate for patients who are getting infused biological medications. Every time I try to move one away from a costly hospital to an outpatient infusion center, I start a war.

Consider the medication Ocrevus, an infusion in a local hospital will run you about $103,000 and no that number is not a typo. For as much as my house is worth, you can get one visit to have a powerful MS drug infused. A patient can obtain that from an infusion center for about $44,000 for the same dose. If you knew that ahead of time, which decision would you make? Did you doctor even give you the option?

For most people I talk to, I hear the same quote over and over. “My doctor said that the infusion center would call me to schedule the appointment.” Health systems intentionally hard code their own infusion centers into encounter notes. Doctors don’t even know they are costing their patients and their health plans thousands of dollars more than necessary. That is blatant fraud, waste, and abuse. I don’t think locking up every hospital CEO will solve the problem though.

Just like your next flight for vacation, you have choices in your health care. Find the lowest cost one. If that sounds too time consuming, find a patient advocate. $50-100 for a patient advocate could save you and your health plan thousands of dollars later.

Don’t just look at the government to save you money in your healthcare. Ultimately we all have an obligation to spend our healthcare dollars wisely. A couple of hints though:

  • A doctor’s office is cheaper than a hospital
  • Infusion centers and outpatient radiology centers do these services for about a third the cost of a hospital
  • Sometimes your pharmacy benefit will give you the best costs. If you doctor will do the infusion in office. Ask them to send the drug order to a specialty pharmacy and sent to your doctor for your infusion visit.

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