An update on fee discounting in medical care.

Is fee discounting by health care providers legal?  Would fee discounting be considered a fair shake to patients or would it be considered patient baiting?

In terms of hospital care, it seems the market is finding fee discounts a very acceptable method of doing business.  Here’s a link to a number of recent article related to fee discounts in medical care.

St. Louis hospitals give uninsured discounts.
SC court says uninsured not guaranteed discounts.
California opens hospital discount listing site.
SC court examines discounts for uninsured.
MN hospitals extend uninsured discounts.
MN health systems pay back uninsured patients.
Catholic Healthcare West uninsureds get 35 percent refund.

Special thanks to www.fiercehealthcare.com for these links.

Jeff
Jeff Oster, DPM
HowMuchDoc.com

Medical costs are causing insured American to avoid medical care.

An interesting article in The Washington Post on 3-25-08 highlighted the trial of insured Americans to obtain and utilize medical care.  The survey was sponsored by The ALF-CIO and relied on 26,000 union members in the survey. 

The article states, ‘Among the uninsured, 76 percent said that someone in their family didn’t see a doctor during the past year when they were sick because of cost. And 57 percent of the uninsured said they had to choose between paying medical costs or their rent, mortgage or utilities.’  For many of us, this finding is not new but rather the reality of every day.

And yet the insurance industry fights back in an effort to preserve their role.  ‘One critic of the survey, Mike Tuffin, executive vice president of America’s Health Insurance Plans, a health insurance company lobbying group, said the findings were at odds with other research that showed private health insurance is affordable and provides good access to care.

“There is a lot of data that suggests that those who do have private health-care coverage are very satisfied,” said Tuffin. One survey found that “87 percent of respondents with private insurance said their health-care coverage gives access to good medical care at an affordable cost,” he said. ‘

In talking to my patients, I’ve yet to find one who’s satisfied with their health care coverage.  Oy! 

Jeff
Jeffrey A. Oster, DPM
Medical Director
HowMuchDoc.com

Is fee discounting legal in medical practice?

One concern on the part of medical providers is whether discounting fees is legal.  Some insurance companies (Medicare in particular) have implied that discounting fees could be considered ‘patient baiting’.  By discounting services, a doctor could possibly be providing unnecessary services that were purchased by the patient solely due to the fact that they thought that they were getting a bargain.

In response to this issue, the OIG (Office of the Inspector General) of CMS (Center for Medicare and Medicaid Services) came out with a recent response to this issue.  At issue was fee discounting by a health care system for patients who pay promptly.  The OIG agreed that discounting is fair and reasonable.

Remember, OIG Advisory decision, like Advisory Opinion No. 08-03, are case specific.  Each case may vary based upon the details presented to the OIG.  But the decision by The OIG does bode well for organizations like HowMuchDoc.com.  In fact, it even says to individual providers that discounting fees for prompt payment is a reasonable incentive to their patients.

Jeff Oster, DPM
Medical Director
HowMuchDoc.com

Direct TV pharmaceutical marketing – a good thing?

I recently read an article in High Country News about a fellow who said his mom was so proud of him.  He had become a doctor.  And he didn’t even go to med school.  All he had to do was to watch TV.  As a result, he learned about depression, dry eyes, restless leg syndrome….you know the ads.

Are these ads good for consumers?  Are they bad?  Do these ads benefit patients by bringing them medications or technology that their doctors perhaps would have overlooked?  In my practice I see many patients that are on ‘these’ medications.  Would they use Restasis if it was non-covered by their insurance or would patients simply use Visine. 

What I’ve seen with my patients is that the marketing of these medications has been very effective.  So much so that many of my patients now seem to have restless leg syndrome when perhaps they didn’t know that they had had it in the past.

Most importantly is the cost of these medications.  For the most part, doctors are kept out of the loop in terms of cost.  We have no idea how much a prescription cost should a patient try to pay out-of-pocket.  How does a pharmaceutical company fund a TV ad campaign?  I think you see the point I’m trying to make.  Direct marketing of pharmaceuticals to consumers isn’t done to help them solve their medical problems.  It’s marketing and marketing is done to sell.

Jeff

Who’d of thought that medicine would be used as a loss leader for larger retail chains?

An article in the 8-8-07 edition of USA Today announces how the Publix grocery chain is going to give away several antibiotics……. free.  The free medications aren’t free to Publix so the intent is obviously to use these medications as a loss leader.  A loss leader is a tool to bring customers into the store.  While in the store, in addition to the medications the customer will also pick-up milk, bread, etc.  And the hope is that the customer will become a loyal customer in the future.  Another version of ‘grateful patient syndrome’.

The blog posts on USA Today following this announcement were somewhat pessimistic.  Many noted that these were already inexpensive medications.  As a physician, I can see no harm.  A reduced cost of care is a reduced cost of care no matter how you wrap it.  Other comments noted the resistance that has been developed to antibiotics.  But hey, you still need an Rx to get the medications.

Who’d have thought that we’d be seeing the art of medicine used as a loss leader for large retail chains.

Jeff