by Dr. Loni Rodriguez | Mar 9, 2020 | healthcare
The rising cost and the decline of quality healthcare has someone like myself upset with the trend. There are a few major factors that play a role. I am going to discuss some of these factors below in hopes to help inform the public of why it is so important to self advocate for the care you deserve.
“Medicine is a science of uncertainty and an art of probability.” (1)
I begin with this quote to help explain modern medicine in very few words. The most important word to process is the word, “uncertainty”. The lack of acceptance with this word is a major flaw in the healthcare system and leads to some of the issues we deal with. The following discusses some of the ways that uncertainty impacts healthcare cost and the quality of care.
Medicine is not black and white. In school, medical professionals are tested with multiple choice questions. Questions that have one right (or less wrong) and 3-4 wrong answers. Test questions dip into the grey but not enough to help the students understand the importance of how grey the professional world can be. This undoubtedly increases the likelihood that medical professionals will perceive uncertainty as a threat. This perception will bleed into how they interact with and treat their patients in the future. With this mindset it becomes more and more challenging to accept uncertainty. It feeds the fire for the search for specific diagnoses and black and white answers. Uncertainty in medicine also factors in when we see different outcomes from the same treatment on different people with the same diagnoses. We hope for positive results but we aren’t 100% certain of the outcomes. That can be scary not only for the physician but also the for client.
Unreliable research. Much of what we study in medical research is backed by sub-par outcomes and poorly performed studies. We are not willing to admit that there is too much that we don’t understand and it is hard work and dedication to stay up on the most recent research. Many medical providers don’t possess enough humility to adapt and change with the times. That being said, the unreliability of medical research has us questioning who to trust and what to believe.
Over-medicalizing. Running multiples tests just to check boxes is what I mean by over-medicalizing. Many tests ordered are unnecessary and simply are performed to check boxes for insurance companies or because the physician is following an outdated protocol. In the world of pain management, the unnecessary tests can lead to unnecessary diagnoses. Many of the “abnormal” findings on tests are actually normal parts of the aging process and have poor correlation with symptoms.
Physician burnout. This topic is a factor, two-fold. The first as to do with the decline in reimbursement rates and the increase in the number of people in need, medical professionals are forced to work harder and harder. The are pushed to see more clients per hour and complete more paperwork than ever before. Both of these factors contribute to a decline in the quality of care that physicians are capable of. The second factor involved here is that if physicians can not embrace uncertainty, they will continue to look for black and white answers, which continues to emphasize the black and white mentality, driving them to the point of questioning why they practice medicine.
- Bean RB, Bean WB. Sir William Osler: aphorisms from his bedside teachings and writings. New York: Henry Schuman, 1950.
by Dr. Loni Rodriguez | Dec 12, 2019 | healthcare
Yes, cute dog just to catch you eye 🙂
Knowledge is Power… Especially In Healthcare.
I am going to assume that some of you are self-employed but I know that many of you work for companies who provide you with a health insurance benefit. Well, even if your company supplies it, it is still INCREDIBLY confusing to choose the “right” plan. You read and search and all the words are big and confusing and it is very difficult to decipher in order to make a decision on which plan to choose. All you want is someone to talk you through it to understand the “investment” you are about to make…
This was me yesterday. It is open enrollment time and the last plan I choose was horrible so I was on the hunt. I am obviously in the healthcare field so I understand some of the verbiage, but even for me it was foreign. So… I called the customer service line in hopes for help.
20 minutes later after a dropped call, 2 different agents, and a wait time I had my man on the phone.
Man: “Hello, thank you for calling XYZ insurance, how can I assist you today?”
Me: “Well, I am trying to compare plans from various providers and I would like to understand a few of the words used in the benefits description of each plan and…”
(Interruption)
Man: “Well, I am sorry ma’am but I only work for XYZ Insurance and I can not answer anything about other plans.”
Me: “I am just looking to understand some of the common words I see, like deductible, and…”
(Interruption)
Man: “We are not able to discuss any other plans benefits except the XYZ insurance plans.”
(Getting angry now)
Me: “Listen. Can you just tell me what out-of-pocket max means if i have a deductible and coinsurance… and what is coinsurance?”
He finally answered me and it turns out that I understood all the verbiage. I just wanted clarification! I wanted him to educate me on HIS expertise to allow me to pick the plan that was best for me and my needs, not sell me a plan or talk about other insurance providers. Not only was it was unbelievable that he was interrupting me and not listening, but that he kept explaining that he could not help me. Once he finally listened, he realized that he could in fact help and did.
The point of this discussion is not to discuss the rising costs of healthcare but to discuss customer service. Since I opened my practice and have emphasized refining the customer experience, I can really see when my experience with another service is crap. This was one of those times. If the man on the phone took his hard hat off and realized that I just wanted to be educated and a bit more informed, I would have been very pleased.
Don’t settle for crappy service… Get yourself educated in every way possible… Knowledge is power!
Interested in knowing a bit more about the confusing health plan words? Here is a quick reference list!
Deductible: What you pay before your plan starts to kick in. Some preventative services are covered and do not apply to your deductible which would include things like yearly visits with your doctor. If you have a co-payment, you do not pay your copayment if you have a deductible, you are just paying your deductible until it is met. This would mean that you are paying for the procedures in full until you hit the deductible Sometimes, you then have a copayment AFTER the deductible has been met.
Coinsurance: A percentage that you still pay AFTER your deductible is met. If you have a 20% coinsurance and a $2,000 deductible, then you are paying your 2k outright and then 20% of all medical costs after the 2k has been met.
Out-of-pocket max: This is the max amount of money you will spend on healthcare in the year if you use your benefits with a participating provider. This includes your deductible, co-payments, AND co-insurance.
Overall, health insurance is not fun and not fair but we live in a world where many healthcare procedures are incredibly expensive when paying without insurance. Did you know that most procedures done in a hospital are more expensive vs at your primary care office? Also, many primary care docs have to refer you for tests done at hospitals and if you do not have hospital-based coverage, you may be hit with a HUGE bill! I’m talking HUGE!
My overall advice… ALWAYS ask the providers billing department what your cost is going to be BEFORE a procedure is done and give your health insurance a call before you do anything.
Ask questions and get informed!
