Opaque Costs Lead to Embarrassment

February 12, 2015

By Margie Coloian

Among the must-haves Steven Weinberger, MD envisions for our healthcare system is transparency of costs. The cost of individual care is a mystery for most patients. The mix of copays, co-insurance, deductibles, facility fees—are all nebulous—until the bill arrives weeks after a medical encounter.

At the Lown Institute’s third annual conference next month, Weinberger and a spine surgery patient will discuss the scandalous and unexpected surgical bill the patient received after his procedure. That bill was from an assistant surgeon, a physician who was outside the patient’s insurance network, and he was someone the patient had not even met. But what was most outrageous was that that surgeon’s bill of $117,000 amounted to more than ten times the fee of his primary surgeon.

The patient, whose case attracted attention from the New York Times, challenged the charges, even though his insurance company would not. In the process, he discovered that such out of network charges are not unusual, and that insurers often pay them, no questions asked. His insurance paid the fee.

“There is no other sector in society where the issue of cost and what one is responsible for is so opaque,” says Weinberger. “And even when patients get their bills, they don’t know what they’re responsible for, who pays for what.”

Even if patients ask for a price up front, he says, many doctors don’t know the answer. “Most surgeons don’t know what bills will come in, say from the physician or surgical group,” says Weinberger. “In surgery there may be many bills, from the anesthesiologist, the pathologist, the imaging studies and hospital-related fees.”

Lack of transparency is widespread and problematic throughout the nation. Yet no group seems to be responsible for doing anything about it. Weinberger believes that involving consumer organizations is a starting point in bringing the cost-issue to the forefront.

“We need pressure from all parts of the healthcare section, the regulatory agencies at the federal and state level, insurance companies and the doctor-provider communities,” he says.

“It’s embarrassing to us that we don’t know what patients will pay,” Weinberger admits.

“If you’re a consumer of a consumer product, and you’re dissatisfied, you can complain to a consumer product organization or company. That happens all the time. But where do you go for something like this?”

Weinberger applauds the work of the Lown Institute, known for doing battle with overuse and misuse of medical services. Like the Institute, the American College of Physicians, where Weinberger serves as executive vice president and CEO, has also been addressing issues involving useless and wasteful care. “Some 30 cents of every dollar is wasted in healthcare,” he says. That is why the ACP developed a “high-value care” initiative, a series of clinical guidelines to be used by practicing doctors, and in medical education to train the next generation of physicians to change the ‘more is better’ culture in the field.

Weinberger has two other must-haves for medicine: universal access because healthcare is a right for all, and a shift to patient-centered care. “Any patient who goes through the healthcare system realizes that the system is not geared to be oriented to patients’ values and needs. It’s a difficult system for patients to negotiate, and it’s run for the benefit of hospitals and providers, not patients themselves.”

Learn more from Weinberger’s session and from all the other speakers, panelists and attendees by attending the conference. Seating is limited. Register now.