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Health care: A cautionary tale

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RediClinic exam room_featuredA column in the metro New York newspaper Newsday illustrates the type of scenario that the Health Care Payment Learning and Action Network, announced last week by the Department of Health and Human Services, is targeting in its efforts to promote health payment models based on the quality and efficacy of care, rather than the quantity.

In the article, headlined “Patients Can’t Afford to Blindly Trust Doctors,” Newsday’s Michael Dobie recounted his experience of being put through a series of tests, an appointment with a gastroenterologist and an endoscopy following an annual physical exam that detected low hemoglobin. He appreciated the doctors’ concern but questioned the need for the tests and the procedure after mentioning that he had recently donated blood. Taking their advice that it’s best to be sure, he decided to go ahead with the endoscopy. The procedure was routine and everything looked good, according to the doctor.

“Then the bills started coming,” Dobie said.

Because his coverage had a large deductible, Dobie ended up being “on the hook” for nearly $4,000. Fortunately, after complaining to the gastroenterologist’s office, he was able to cut the cost by more than half.

“The moral is that this is where health care is heading. Those big deductibles … mean we have a lot more skin in the game. Now it’s our money we’re spending,” Dobie wrote. “We need to ask questions and need to be better informed.”

At the launch event for the Health Care Payment Learning and Action Network — in which Rite Aid, Walgreens and Walmart and participants — HHS Secretary Sylvia Burwell noted that it’s “in our common interest to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people.”

Undoubtedly, Newsday’s Dobie would agree.

“Understand, I’m not blaming doctors. Most prefer to err on the side of caution. They don’t want to make mistakes. They don’t want to miss something. And that’s good,” he wrote in his column. “But most of us don’t want to pay for things we don’t need. That means getting information, evaluating risks and making good decisions.”

Indeed.


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