When it comes to lowering your medical costs, hospital doctors is not the way to do it. A recent study in JAMA (Journal of the American Medical Association) compared the costs for patients seen by hospital owned physician groups compared to independent physician owned groups in California
The researchers in this study found that for physician groups owned by local hospitals, the average cost per patient was 10.3% higher than for physician groups owned by physicians. The average cost per patient for physician groups owned by large healthcare systems with multiple hospitals was 19.8% higher than the cost for the physician owned groups.
This study is just one of many that have shed light on the fact that hospitals charge more and get paid more, than independent doctors.
What does this mean to you in the long run?
1. Higher medical bills and health insurance premiums from hospital chain’s collective bargaining power.
Monopolistic hospital chains are using their political leverage to drive up medical costs for everyone. The Bloomberg piece investigates cardiologists, but the dynamic works in exactly the same way in neurology and other specialties. The cost for an identical service can be as much as three times higher in a hospital. That’s enough to really financially harm patients, both with high copays and deductibles now, and higher monthly health insurance premiums down the road.
For instance, under Medicare’s tangled payment system, hospitals get higher reimbursements than individual doctors for cardiology treatment, as they do for other specialty services. In some cases this is as much as three-to-five times more. At the same time, the added bargaining power gained by controlling more of the heart care in a geographic market has given large hospital systems added leverage in negotiating reimbursements from insurers, such as UnitedHealth Group Inc. and WellPoint Inc.
2. Your doctor working for a hospital chain will have less time with you to treat and diagnose your conditions.
Doctors employed by hospital chains have to be focused on the numbers and bottom line. This means they are obligated to see as many patients as possible and keep the patients coming and going through a revolving door all day. And they oftentimes want to keep you in their system, because sometimes their salary is dependent of how much money they generate for the system.
For example, let’s say you’ve had splitting headaches the whole week and you decide to go and seek treatment from your primary care physician who is employed by a hospital chain. Ignorance, combined with a pressure for speed, is what leads the hospital-employed doctor, who most likely is not a specialist in headache, just to reach for the script pad to treat your headache. If you get to see a headache specialist, you may have to wait weeks or months. Your alternative is to go to the expensive Emergency Room of the hospital, where the charges will rapidly add up to an enormous bill for services that will result in temporary relief at best.
This example is true even of many so-called headache specialists, who emphasize drug treatment and prophylaxis for nearly everybody with headache. This could be because either they are unaware of the powerful triggers of sleep disordered breathing and neck hyperextension to breathe during sleep, coupled with neck problems caused by the way we live our lives in the head forward position during the day. Or, simply because of their disclosed or undisclosed links to the pharmaceutical industry, or the time pressure generated by hospital-centered care.
3. You end up paying more for the same level of care
In a New York Times article, hospitals are constructing compensation in ways that are based on productivity and performance, according to Steve Messinger, president of ECG Management Consultants, which advises on physician acquisitions.
But the consolidation of health care may be coming at a hefty price. By one estimate, under its current reimbursement system, Medicare is paying in excess of a billion dollars a year more for the same services because hospitals, citing higher overall costs, can charge more when the doctors work for them.
Laser eye surgery, for example, can cost $738 when performed by a hospital-employed doctor, compared with $389 when done by an unaffiliated doctor, according to national estimates by the independent Congressional panel that oversees Medicare. An echocardiogram can cost about twice as much in a hospital: $319, versus $143 in a doctor’s office.
So always look for a doctor who is not employed by a hospital system or chain–an Independent Doctor. If you’re not sure, ask the office staff or that doctor. If you have to go to a doctor who is employed, either because of insurance or otherwise, ask someone who works in the hospital who they would go to.
Independent Doctor lists and organizations are starting to be formed around the country, to advocate for “price transparency” and prior notification about facility fees to patients, so they don’t get stuck with hidden fees. Kansas Independent Physicians, Inc., is an example of one. State legislation is being considered in Kansas, as well as in other states, that requires hospitals to disclose to patients before they come to see a hospital-employed doctor, that they will be paying a facility fee. These requirements are already law in Connecticut.
Registries of Independent Doctors will be formed in other states. In the meantime, patients who need non-emergent care can be their own best advocates, and become pro-active about their own health care. For tips on how to find a really good doctor, see that post. That doctor oftentimes will be independent, with only your interests in his or her mind.