For decades, the majority of patients have traveled to an appointment with a physician with one thing in mind: “treatment.” Regardless of the cost or available evidence, most patients trusted physicians with a “you’re-the-doctor” attitude and took whatever medication was prescribed. However, today’s system is rapidly evolving. Patients are now researching their symptoms and diagnoses. Often times they may be overdoing it or relying on inaccurate information, but none the less, our society is now full of educated patients. In a system that was historically too physician-centric, and now pharma-centric or payer-centric, it is about time that patients have a say in what happens to their own bodies.
Question #1: Has this been proven to work?
In most industries, the “value equation” is rather simple. If a customer finds the benefit of a product or service greater than the necessary sacrifice needed to obtain it, then a transaction is made. This gets a little more complicated in healthcare, because the sacrifice is not simply financial. Patients can often experience permanent changes to their bodies, lifestyles, and even personalities after medical treatments. Cleary, patients deserve every available piece of information concerning medical treatments, but this isn’t the reality of the situation just yet.
When someone is in the market for a kitchen oven, s/he can browse the websites of retail stores and usually find hundreds of detailed reviews, ratings, and recommendations. However, if that same person is considering a knee replacement, the options are far more limited and often convoluted. Ideally, patients can read through the basic WebMD description, skim cautiously through patient forums, and then move on to get real evidence from a peer-reviewed journal. Unfortunately, this last step requires a basic knowledge of statistics and access to the paid-access sites that host this information. The patient then settles for incomplete evaluation and is expected to make an educated decision about a life-impacting event. This is certainly not the best we can do. This is definitely an area of opportunity to improve the industry and companies could benefit greatly by taking on the task of educating patients as the demand rises.
Moving on, consider that a full evaluation of a treatment like a knee replacement also requires a review of the surgeon performing the procedure. I’m sure we all know how difficult it can be to objectively review a service provider. The simple truth is that two surgeons with identical skill-level, will be graded differently depending on his or her personality, mood, and wakefulness on a given day, as well as the patient’s personality, mood, and wakefulness on that day. For better or worse, we are social creatures and even today one of the most trusted forms of research is word-of-mouth. Nothing is more comforting than hearing great reviews from familiar people who either had direct experience with a product or service. More weight is placed on the opinions of trusted family, friends, and colleagues, but increasingly, online reviews from strangers are being relied upon, especially when in greater quantities.
Question #2: How much will this cost?
As I have previously written, customer service in healthcare is coming. Please don’t mistake that as an emphasis on smiling staff, free coffee, and quality dining in hospitals and medical offices. Yes, the “on-the-surface” customer service will almost be mandatory for a successful system or practice, but in the next decade, patients going to focus much more on the core of the experience. They want to see through the fluff. They will want to know if treatments are going to work or not. Then, to move forward, they will want to know how much it will cost them.
Healthcare is unique in that it is an industry that provides pricing for goods or services after the purchase. In the past, patients were often surprised by crippling medical bills weeks after a hospitalization or treatment. Adding to the issue, after reviewing the bill, patients would notice that the costs of items like towels or surgical markers were inflated with mark-ups well above one hundred, or even one thousand, percent.
The obvious answer to this problem is the same as every other industry: price transparency. It does not seem onerous to provide patients with prices before a medical procedure, especially if it is elective. As for emergencies, one possibility would be to list the estimated costs of common emergency department visits or hospitalizations. For example, at Hospital A, what is the expected cost of a 3-day hospital stay for a COPD exacerbation or a quick splinting for a broken finger? Surely some patients would go for the cheapest hospital and others for the most expensive. Maybe patients would go to the “high-end” hospital for a heart procedure, but to the less expensive urgent care for an ankle sprain. In any case, price availability will create this choice.
Fortunately, when patients gain open access to prices and outcomes data, the system is going to change for the better. For the first time in history, power will be given to the person swallowing the pill, risking the knife, or losing blood. These ill and vulnerable men and women reveal everything to get an answer or a cure. They deserve to ask, “Where is the proof and how much will it cost?”