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In yet another terrific discussion on our members’ listserv, Casey Quinlan of Mighty Casey Media (Twitter @MightyCasey, @CancerForXmas) gave powerful voice to a patient’s perspective on controlling medical costs. I asked her to write it up. Go, Casey!

First, let me say up front that I am one of the uninsured. Given my circumstances, it’s critical for me to ask what my healthcare costs will be, because I’m on the hook for 100% of those costs. Asking that question gets me answers that range from “I have no idea” to “it depends” to “if we do A, it will cost $X, if we do B, it will cost $Y”. I’ll let you figure out which answers move me toward a decision, and a healthcare provider. Again, I have to ask. I pay every dime of my healthcare costs.

Why isn’t everyone asking how much their healthcare/treatment costs? I think the reason can be found in the first answer I outlined in the previous graf: most providers don’t know what treatment costs, because the varying types and carriers of healthcare insurance have equally-varying types of reimbursement and payment schedules. They’re all based on Medicare reimbursement rates, but even those will vary across geographic regions, and in some cases within metropolitan areas.

The healthcare industry says that it’s different than any other industry, and that’s why its pricing is so variable and opaque. I say it’s past time for them to tear down the wall between what they do and what it costs, making cost information available to patients. Whatever your views are on healthcare reform, you have to believe that the healthcare market should offer patients some choice on who treats them, and where that treatment is delivered – even if that treatment is just an annual physical. That choice has to include cost transparency, which is a critical part of evaluating Relative Value (I capitalized that on purpose – stay tuned for the reason why in an upcoming graf).

Even in limited networks like HMOs, the actual cost – to everyone paying in: the insurer/system and the patient – should be visible. Transparent. Easy to determine. Full disclosure: as much as my personal experience with HMOs made me loathe them, as an uninsured human I kinda (but only a little bit) miss those olden days. But since I am an uninsured human, who self-pays for the care I know I need, and keeps her fingers crossed against any attack of the Really Big Disease(s), knowing what treatment options might cost before I make a healthcare purchase is a critical bottom-line question. One that demands an answer before I can make a decision – an informed decision.

That Relative Value equation starts there for people like me. For those with insurance/HSA options – HSAs aren’t available to me, since I don’t have insurance, since it still ain’t affordable in my part of the country – notw knowing from jump what your costs will be for a treatment/care option opens you up to all sorts of nasty surprises. Understanding costs, evaluating options, and making choices based on what the Relative Value is of those costs and options is. That’s how patients can craft and deploy their own version of a Relative Value Unit protocol.

The healthcare industry knows what its products and services cost. An American Medical Assn. group called the RUC (full name: Specialty Society Relative Value Scale Update Committee) is a committee of 29 doctors who meet regularly, behind closed doors, to develop Medicare’s Resource-Based Relative Value Scale. Those are the procedure-by-procedure price lists for all the things that Medicare covers. Which is all of healthcare. That’s not considered price-fixing under federal anti-trust rules because the RUC hands off its price list to the Centers for Medicare & Medicaid Services (CMS), who publish it.

Back to my point: patients must start asking cost questions. Even if that cost question is just about an annual physical. Because until the customers of healthcare – patients – start to participate fully in the transaction by asking about cost, the healthcare system’s pricing will remain opaque, and the industry willnever be able to get a handle on cost control. It’s like trying to steer an oil tanker when the wheel isn’t connected to the rudder: you can’t steer away from the rocks. We – patients – need to take the wheel, and we need to make the rudder connection by asking a simple question: what will that cost? Question by question, we’ll steer an entire industry away from the rocks that are sinking it, and us, under a crushing wave of runaway costs.


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