Docs taking real action

For example, my mother had blood work drawn at her oncologist's office last week but when she had to go to Duke this week they drew the exact same blood work again! Why with all the modern electronic devices we have can they not share this medical information. I asked this of the transplant MD at Duke and he stated "well our labs are different then theirs and we like to run them again here". Well Mom gets to pay two copayments for her lab work and diagnostic tests cause a MD prefers their equipment? Doesn't make sense to me.

And after they draw blood and have the same tests performed numerous times by different doctors when will someone identify that there may be a problem here?

A family member suffered from an illness and ended up having the same (expensive) test performed 6 times by 6 different doctors over the course of two months. My family member had no history of medical problems.

Why can't technology flag that something was wrong. My bank baselines the use of my credit card and will call me if it sees something out of the ordinary.

Early identification of the issue would have meant taking medication and resting. Because of the extended time to diagnose we spent a week in the hospital and it cost over $100,000.

You did the right thing and places like Duke need very much to do bloodwork over. Their labs ARE different.

We had a member of family who was told by some quack that ran $6000 in blood that they had hemophilia.Now, that is a very huge diagnoses with many many ramifications for other family members.

They went to Duke where they re-did the tests and showed it was NOT true at all. The lab had made many mistakes in other tests, too.

Further, the Dr at Duke told him to ONLY have further blood taken there .

Labs are notorious for mistakes and getting people mixed up.

Rick- this is why it is important to find a good dr and stick with him or her. Labs are different and "normal" levels even differ by region.

The system still rewards doctors for performing tests, repeat visits, and other things that revolve around people staying sick. Why can't a doctor be rewarded for getting a patient to lose wait or quit smoking therefore not needing insulin or high blood pressure medication any longer. We need to make it more rewarding for doctors to make people healthy as well as them being paid to treat people who are sick.

While that is an excellent option, the problem is you cannot co-relate what a patient does based on advise a Doctor might or might not have provided. If a patient lost weight 2 months after seeing a Doctor, how would you know if it was a result of the Doctor's visit? In most cases, we visit a Doctor to get cured of an illness at a particular time and the Doctor's main goal should be to provide quality affordable treatment at that time. What transpires as a result of that visit a few month's down the line is completely different.

Where do you live that doctors get rewarded for healthcare. Our specialist practice does not. If anything we are constantly fighting for the patient to be able to have the test that we feel are very necessary. We fight to just get paid enough to keep the doors open. We would be rich if we got rewarded for this. We always encourage stopping smoking and losing weight because we deal with neck and throat cancer and sleep apnea. They usually never stop smoking and don't lose weight.

Invest in electronic medical records and start talking to each other, share information. Duplication of services and polypharmacy particularly in the elderly population costs an enormous amount of money. What happens when you over medicate someone? Someone who does not metabolize medication as well as they used to? They fall, they fracture their hips, they bump their heads and have cerebral bleeds. I could go on and on........

I agree. Why do I have to constantly regurgitate all of the relevant details for a family member who's unable to communicate? HIPAA privacy laws prevent me as POA from accessing her medical information, so I usually sit there and shrug my shoulders and say "I don't know" because I honestly don't. And there's always at least one issue in her records that I know of is wrong, but no one seems to be empowered to change it. Why can't this information be centrally stored in one place?

Doctors can start by posting standard charges for basic services at their offices allowing patients to be aware of medical costs. Even though, the charges might be discounted by network discounts and patients end up paying a percentage (or copay) on the discounted amount, many patients are unaware of the true charged amount until after receiving an EOB or a bill from the doctor.

In addition, at the end of every office visit, the doctor should be able to provide the patient with a list of services provided and the charges for each service. This would avoid surprises later when the patient receives their bill (or worse a denial on their claim). It also allows the patient to question certain charges right there at the office. Why should a patient leave a doctor's office not knowing how much the services cost them?

The problem is that all insurance companies allow different amounts for the same procedure. The only way to be able to give the patient that information is to create a fee schedule on every charge with every single insurance company. There is so many insurance companies there is no way you can do that. Insurance companies are always changing how much they reimburse based on the medicare allowable and changing rules on what is covered and what is not. It is just as frustrating for the doctors office as it is the patient. Patient's should also know there benefits and what is covered under their plan. It is not your doctors office responsibility to know what is covered under your plan, how much your deductible is, and what % you are responsible for after you meet that deductible. If you give the patient the cost that you bill their insurance, they will sometimes refuse treatment even though they will not have to pay as much as they think. Very frustrating for everyone!!

I agree. My Dr. did not know the cost of any test that was ordered for me. I got a bill for $400.00 for 1 test, with insurance. And on top of that, the Lab used was out of Network, IF in Network had been used the cost to me would have been less. My bad, next time I will be sure to request in Net Work Labs.

Irrespective of the amounts allowed by insurance companies, the starting amount is always the same i.e. the amount the doctor would charge the patient directly if they did not have insurance or if the insurance company denied the claim. In my opinion patients should always be aware of the charged amount not just when they have to foot all or part of the bill.

Beautifully put.

How can patients know what test are covered or not covered? We are not Doctors we do not have the training or knowledge to know every test and if it is covered or not. I think doctors should have to give estimates just like auto repair facilities do for work that is over $300.00. If the bill comes back 10% more than the estimate and you did not approve the overage you should not have to pay it. I think similar legislation for doctors should be put in place.

I have an HSA and find that although doctors are getting more used to these types of plans, they still seem slightly annoyed by them since they patients are driven to ask more questions about how much various services cost (since it comes out of our pockets). I echo Steve F's post regarding the suggestion that doctors post prices for standard services. If I can take my dog into a vet clinic and have a cost break-down prior to a procedure, it should be just as easy for an MD to do this. It should be standard procedure. My two cents.

Abide by these clauses of the modern version of the Hippocratic Oath:

"I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism."

"I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick."

Discuss preventative and non-pharmaceutical interventions for basic lifestyle-related diseases. Examples: diet changes, sleep, exercise and better work/life balance could save our health care system much of the the exorbitant costs of heart disease, diabetes, depression, ADHD, reflux. I am a healthcare worker who is furious at the lack of personal accountability for our own health and wellbeing and for that of our children.

I also work in a healthcare facility and am amazed at the number of people who come in for their visits with a bag full of different medications. Each medication has side-effects which sometime cause other side effects resulting in the need for more medication! I totally agree that providers need to discuss alternatives to medications.

I have to tell this story: A patient was recently diagnosed with diabetes and told that he can make lifestyle/dietary changes or he would need to be on medication. The patient chose the medication because the dietary changes "would be too difficult". Sad but true story

Lori- I challenge you to do the same things you suggest to your patients. There are many drs with eating disorders and drug problems who cannot practice what they preach and they have enough money to eat at Wholefoods all day.

Most people who lost weight (more than 85% gain it back and more-causing a greater health burden. You should know this as a Dr and that you do not is startling. Maybe you are not a Dr.

If you want to help, you need to send those who cannot change to an effective behavioral therapist who practices evidence based therapies.

Health insurance will have to pay better mental health coverage to make this happen.

You cannot just tell someone to do it without any help.That is absurd.

As a doctor's assistant, I talk to a lot of people looking for a "magic pill" to solve any problem you can think of. They want instant pain relief and easy weight loss. Those who are on oxygen for COPD but continue to smoke really amaze me. I know it's not easy to quit smoking but it would make breathing so much easier.

When I was diagnosed with a condition my Dr wanted me to have surgery. I was told the ONLY treatment was surgery. At no time was I given any other option. When I got home I did an internet search and found a non surgical option. When I went back to the Dr and requested the non surgical option the Dr looked at me and said, why do you want that? Of course with attitude. I avoided a major surgery with a $120.00 remedy. Needless to say I changed Dr.

This Dr had no problem putting me in debt and max. out my insurance and putting me in risk with major surgery. Whats up with that?

Be honest and fair with billing.

I am the billing manager for a independent surgery practice and in our practice we advise patient's of their benefits either in or out of network, along with approximate costs prior to their visits with our clinic.

If we suggest equipment, we put the estimated portion in writing and explain how the benefits apply toward the item, allowing for an informed decision whether to purchase from us directly, take a prescription to an medical supply company, or search it out on the internet.

If we suggest surgery, we provide a written estimate detailing the procedure codes and description, our contracted rate (if we have one) and apply the individual benefits as verified within the last 48 hours. If the estimated balance is larger than is affordable for varied reasons, we do extended payment plans, provide financial counseling, and do charity or hardship discounts.

We want to make certain that our patient's know exactly what they are getting and encourage getting second opinions and/ or shopping around. Not every doctor is a perfect fit for every patient and in the end it is more important that they get the care they need than whether they choose our office. I personally hope people come away from my office more informed about their condition and their insurance benefits than before they were before.

Stop prescribing unnecessary drugs that were peddled to them by some kid on a golf course.

You're implying that doctors have time to play golf. Do you not think they get tired after getting called in at 3am for emergency surgery and working a full, busy office the next day? Sure the office closes at 5, but the last time i checked, very few golf courses are open at 1am, the respective time a surgeon finishes up his/her duties at the hospital.

So Jon D are you implying doctors never have time for golf?

To me, the cost of technology and brand name prescription drugs are the two most significant cost factors. One MRI can cost the same as complete primary care for 2-3 years for the average patient including physicals. Patients don't ever think of the cost of tests as insurance is paying. I've had patients scoff, when I mention the cost of tests, saying, well that's what I have insurance for. I push generics now, without any prodding from Blue Cross. And I encourage prevention rather than expensive treatment. And I discourage MRIs for back pain unless absolutely essential due to severity of pain or neurological problems.

Doctors could electronically share data, one to another, with the patient's permission to eliminate tons of paper work and repeated forms filled out from one office to the next. I'm not talking about FAX since that also requires paper. This would save time, money, errors, AND insure that all doctors working with one patient are on the same page. It would eliminate duplicated tests such as blood work, MRI's, X-Rays, etc.

Riely W

I think one thing doctors could do to bring down the cost is read medical journals so they are up to date. Maybe if doctors were up to date on medications then an American dying from taking their prescribed medications as directed every 5 seconds would decrease therefore decreasing the chances of malpractice lawsuits. It's sad when I have to educate my doctor on the latest studies published in The New England Journal of Medicine.

I have a question for any doctors in here. Why is a shot of cortisone in the shoulder considered a "surgical procedure"? My latest shot of cortisone cost over 400 bucks because it was considered a "surgical procedure".