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Innovative Healthcare Cost Containment: The Economic Informed Consent

By George Lundberg, MD

georgelundbergJust as “all politics is local”, so is all medical care personal. One patient; one physician; one moment; one decision. And in this era of balanced physician and patient autonomy, that decision often is an informed joint decision. Many patients now make serious efforts to learn about their conditions both before and after visits to their physicians. Many physicians welcome such informed patients and willingly discuss comparative effectiveness of the available diagnostic and therapeutic options. However, a frank discussion about the comparative costs and charges for the options, whether they be to the insurance company, Medicare, Medicaid or out-of-pocket for the patient, is usually missing.

Many health economists insist that the medical marketplace does not behave like other markets and believe it is fruitless to expect market principles to usefully inform the medical arena. That bias is true in emergencies,
operating rooms or intensive care units, and with patients who are mentally disabled.

Such behavior does not have to persist in an outpatient setting. In my book Severed Trust: Why American Medicine Hasn’t Been Fixed (Basic Books, 2000, paperback 2002), I presented the concept of “the economic informed consent.”

I believe that every patient who is mentally competent and in a non-emergency situation should be informed of the cost of a proposed diagnostic or therapeutic procedure or product, before it is “ordered.” This includes referral to another (often more specialized and costly) physician, no matter who pays the bill. The costs should all be discussed IN ADVANCE decision. This discussion should include whether it is worth it and
whether there a less expensive good alternative.

A recent NPR/KFF/HSPH survey reported that 55% of Americans believe that their insurance company should have to pay for an expensive treatment, even if has not been proven to be more effective than a less expensive
treatment. This attitude underlies the ruling convention, “if insurance will cover it, do it,” that lies at the root of our problem of health care cost inflation. No one is held accountable.

If we as a country could widely apply the “economic informed consent,” physicians and patients would become educated together. They could both become wiser shoppers for the most cost-effective diagnostic tests,
prescribed drugs, and specialists.

With an “economic informed consent,” physicians and patients can reset attitudes toward a healthy concern for the total costs or charges, stifling the usual knee-jerk response, “if the insurance covers it, do it.” No one
knows whether this approach, diligently applied, would actually cut down on wasteful spending, such as choices that drive huge geographic variations, but we do know that pricing an automobile, an airplane ticket, a dinner or a bottle of wine does affect consumer decisions. Why not try it for medical charges as well? Current sweeping proposals for health system reform all state that there must be “cost control” but offer little likelihood of delivering real cost savings.

Now is the time for the US Health Information Technology Initiative to create inter-operative systems that would provide the data to support widespread use of the “economic informed consent” in a timely fashion and
let the medical marketplace speak. Knowing the cost of a medical decision in advance should become a part of a new “Patient’s Bill of Rights”. In a medical care decision, it is the right of a patient to know “who pays whom
how much for what.” All of us in health care laud “transparency”–let that include economic transparency.

George D. Lundberg MD
President and Board Chair,

Private Sector Solution Offered To Medicaid Patients In Arkansas

Beginning July 1st, eDocAmerica began offering eDoc services to Medicaid recipients and their families in Arkansas. Since there are about 800,000 Arkansas Medicaid recipients, when added to our previously covered clients, this program takes us a long way towards offering the benefit to the majority of Arkansans.

It is especially exciting to begin offering a cost effective health care benefit to this large, underserved population. eDoc services can help with so many of this patient population’s needs, including whether a child needs to be taken to see a doctor for acute care needs, to provide information that can help a patient determine if a second opinion needs to be sought for a given care situation, to provide information about medications that patients are on, to provide information to families of nursing home patients that they can use to ask intelligent questions about their family member’s care, and many others. For nursing home patients, we encourage family members to log on and ask our professionals questions about their family members anytime, for any reason.

It is a daunting task to effectively communicate the availability of this benefit to this group of patients. We’ll be working diligently over the coming weeks and months with the Arkansas Minority Affairs Commission, the Arkansas State Health Department, the Community Health Centers of Arkansas, Area Health Education Centers and Arkansas State government agents to increase awareness of this program and encourage its use.

One of the barriers to this program’s success is that many patients either won’t have a computer, or won’t have access to the internet. We have addressed this with a toll free number (877-581-3362) that Medicaid recipients can call to ask their question. Our call center is staffed by trained nursing personnel who will relay the message to the professional staff and then call the patient back after the answer has been posted.

In addition, we are finalizing an iPhone application that should be ready to go within a short time. We hope to use this new initiative to begin to address some of the health care disparities that exist in the state.

I hope that we will soon see the day that every single resident in our State, insured or not, will be able to log on ask one of our professionals a question that will, in some small way, improve their health!

*This blog post was originally published at eDocAmerica*

The First iPhone Doctor

Who has never heard about Jay Parkinson, founder of HelloHealth service, the first online medical practice? Now please meet Dr. Hodge, the first iPhone doctor.

Hodge’s start-up Personal Pediatrics aims to equip a fleet of self-starter pediatricians in major metro areas with iPhones, cloud-based practice software and the marketing know-how to court new parents, families and corporate health programs alike. The company’s plan points to a growing trend of doctors returning to what was once a mainstay of the profession: the house call.

Hodge has already established that the iPhone doctor model works — after more than a decade working in a pediatrics office in St. Louis, Missouri, where she saw up to 35 patients a day for about 10 minutes each, Hodge traded in the patient assembly line to launch Personal Pediatrics. That was three years ago. Back then she had her laptop and Palm Treo in tow.

personal pediatrics

I have to mention one thing first. The whole health 2.0 movement is not about transforming the healthcare system into an online service, but there are more and more people who want to reach healthcare services through online or mobile applications.

If there are no patients who want to be online, no doctors will build such services. That’s how it works.

*This blog post was originally published at ScienceRoll*

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