Today was a bit special as I reviewed our family 2010 health benefit plan. We live in Chicago and our three children attend schools in three states other than Illinois. In short, we’re all out-of-network except that I work several days a week in East Central Illinois where our in-network benefits apply. As my employer has creatively sought solutions to the high cost of health care, my out-of-network benefit is, well, out of my pocket! As I explained the importance of getting our care in-network to my wife and one of the children, there was silence. Finally the first question, “So what is so special about those in-network doctors?” My answer, “They cost less, I think.”
I’m really quite proud of the quality of care our in-network physicians provide, but I can’t say why. Unfortunately I have nothing public to review that has meaning to me, or my family. There are no quality or patient satisfaction metrics to review unless I bring out proprietary information. There are no procedure counts by doctor should someone ask, “Doctor, how many of those have you done?” We don’t see the readmission rates, the infection rates, nor the overall cost of a likely work-up or procedure. We don’t really even know if the 20 percent in-network copayment for a colonoscopy will be less than the 50 percent out-of-network copayment somewhere else, though the odds are good that in-network services are cheaper, particularly given that big out-of-network deductible.
It is my choice to live out-of-network. And it is a matter of choice where I and the other four members in our family choose to get their medical care. As a consumer I’d like to know something about the services I’m about to choose, in-network or out. And I’d much prefer my employer contributing to my insurance costs and letting me shop around for what is best for me and my family.
To us, we regard our health care decisions as very important. We don’t really like the idea of government or employers telling us what to do. We would like more transparency from the providers so we don’t have to bug them or their business offices with questions they probably can’t easily answer. If Health Reform wants to do something for us, make the providers post their results in the open market, and post usual and customary prices. Give me the right to shop for the best insurance plan for my family, using the network of providers we believe are most convenient and of highest quality. By decentralizing (giving me the power to choose) rather than centralizing (Washington or my employer chooses) the choices, I’m empowered and accountable. And we might be able to make some deals!
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3 comments:
I don't doubt or fear the qualty of PCPs in my network of physicians. I worry for the ability of specialists. Let me tell you why.
My cousin was born with Transpositional Greater Vessels, a serious condition nowadays. 37 years ago they didn't expect him to make it through surgery let alone his first birthday. His surgeon (Dr. Hurwitz in Indianapolis) did remarkable work that has allowed my cousin to get married, have a family, work 60 hours a week as a HVAC technician. The miracle has run its course though as my cousin needs another surgery soon.
He moved to Diller Nebraska when he got married and the doctors at his local hospital told him there was nothing they could do and put him on oxygen and basically told him to live easy for as long as his heart would let him. We're lucky though to have a thoracic surgeon in our extended family who told us that the surgery my cousin needs is readily performed outside of Nebraska. He told us that the best of the best were the ones writing the papers that get published in medical journals. He explained there were two kinds of doctors those that did the work and those that read about it.
He gave him a list of several doctors (all outside of Nebraska) who were doing these surgeries now. He explained there may be a doctor in Nebraska who could do the surgery but they weren't making themsevles public that he could find. My cousin decided to come back home where he could see a colleague of Dr Hurwitz.
It made me think; does my current network of providers contain a doctor the caliber of a Dr. Hurwitz? And if not, am I putting myself in the same predicament as my cousin? How many doctors at the two hospitals we have here in town performed this surgery on a 1-day old? If there are physicians like these in the network, shouldn't this be lauded by our marketing department that we have the premier surgeon in whatever field? Wouldn't that make the consumer feel that this network contained the most bang for his buck?
You hade mentioned early that perhaps we could incentivize doctors to pracitce in places like Diller, but could we truly incentivize great doctors to go there? Which brings up another thought, nationalized healthcare quality of care will still be based on the wealth of the consumer. I cannot move to Berkley or Cleveland if I have a serious heart condition, so do I just get the best there is available? For my cousin that would've meant a slow death. Fortunately he had the means to move and not needing to work for months.
You raise several great issues for consideration. Most truely talented folks like Dr. Hurwitz have two common personality traits that accompany their talent. On almost a daily basis they privately engage in self-talk and reflection around past failures. They understand their past mistakes in painful detail, and are humbled. Fortunately, their inner strength allows them to move forward putting the past behind. In short, Dr. Hurwitz, like everyone, was not always great. And he may also have not been great once he aged and his eyes began to fail resulting in prolonged bypass times, directly related to complication rates. Finally, Dr. Hurwitz may well have trained in a busy inner city facility and made many of his earlier and more serious mistakes on folks who were uninsured or underinsured. The reality of these training environments are they often produce some outstanding physicians, partly because of resource constraints and the opportunity this creates for a serious learner. This is much less an issue in 2010 than the past.
A second issue is the distribution of great doctors who do very high end procedures. The calibre of doctor like your "Dr. Hurwitz" need a large facility with lots of infrastructure support and patient volume. Many times I've seen Dr. Hurwitz-like physicians recruited (with incentives) into smaller environments which wanted to grow a new program, only to fail. The supporting institution didn't fully understand the needed infrastructure costs and the patient volumes were inadequate for a great surgeon to remain great. High complication rates surfaced and the program eventually failed. And yes, I agree the incentives were not helpful in the end. Fortunately, very large facilities with huge volumes are only critical considerations for a handful of problems. Most community hospital environments serve us well for most stuff.
Now, 37 years later and older, your cousin is in a tough situation. You need a way to evaluate who the "Dr. Hurwitz" is in 2010 and how to get him. Perhaps your extended family member can help? Wouldn't it be great if such information was at your fingertips and current? Short of this help, I would start my search with a high volume cardiac center. Then, I would talk face-to-face with the surgeon, explore his/her experience, and then carefully look for those personality traits I mentioned. All really great people have them! Good luck.
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