Wouldn’t it be nice if shopping for healthcare was as easy as buying a new pair of shoes?
Instead, you go to your primary care physician, who refers you to a specialist, who tells you where they will perform the procedure. But they usually won’t tell you what it’s going to cost you unless you ask, and they definitely won’t tell you that you can have the procedure done somewhere else for less.
Most people don’t think to ask about cost-saving options when it comes to health care. Even if they do, a 2015 study found that 72% of patients never broached the subject of cost with their physicians, even though 80% said they would do so.
Transparency in health care pricing is almost nonexistent, but it doesn’t have to be that way. It’s about time you stood up for your rights and started asking questions about your health care costs. You should know that you don’t have to blindly accept your physician’s referral, because there could be a better, more cost-effective option out there.
The Hidden Process of Health Care Referrals
The Wall Street Journal published an article in December 2018 to examine the hidden coordination involved in how physicians make referrals. Hospital groups are practically monopolies, owning everything from the hospital’s operating room where your procedure is performed to the practice where your primary care doctor works. Physicians who work for these hospital systems often face penalties when they refer patients to a specialist or a surgery center outside their system. Within the healthcare industry, this is referred to as “leakage,” and it is actively monitored by many hospital systems. If the hospital administration feels that a provider doesn’t have enough internal referrals, they pressure the physician to bring up their numbers or face consequences.
The hospital loses money if patients go somewhere else, and they want to protect their bottom line. A 2016 survey by Merritt Hawkins found that hospitals earn approximately $1.8 million each year from referrals for tests and other services, internal-medicine hospital admissions, and practice revenue from employed physicians. The health care industry is a $3.5 trillion business in the US, and per capita spending is higher here than any other developed nation. Hospitals want some of that money, so they pressure their physicians to keep patients within their system, and the patients end up bearing the costs.
Shopping for Health Care: High Quality Care and Transparent Pricing
In the past, we’ve been conditioned not to ask questions about medical pricing. We have put ourselves 100% in the hands of our doctors, assuming that they will do whatever is best for us.
But think about it like this: if your cell phone breaks and you need a replacement, do you buy whatever phone the salesperson recommends without checking the price? Of course not. So why should our medical care be any different?
Luckily, the culture of keeping health care costs hidden is dying out. People are demanding the ability to price shop for their medical care just like they can compare car insurance companies or household items. However, the hidden cost culture isn’t dead yet. In the midst of this evolution, youhave to advocate for your best interest.
Studies have shown that the costs of common procedures are up to 40% less when done at an independent facility compared to a hospital. The websites Healthcare Bluebook and Medicare.gov Procedure Price Lookup (for Medicare participants) can show you the average national cost of common procedures when performed at hospitals vs. independent facilities like ASCs (ambulatory surgery centers).
If you have insurance, preventative procedures are often covered 100% at independent ASCs, and diagnostic procedures usually have drastically lower prices than hospitals.
While it may be easier to simply go with the flow and accept everything your doctor says, a bit of investigation could save you a lot of money. If your physician refers you to a hospital-owned facility, ask why your doctor prefers the facility and ask for a cost estimate. Then, go home and do a little research. Looking up some websites and making a few phone calls could save you hundreds of dollars!
Remember that you ultimately decide where to have your procedure, and you have a choice when it comes to your healthcare. Independent ambulatory surgery centers like Digestive Health Centers can ensure you get high quality care that fits your budget.
Visit A Digestive Health Center And Save on Health Care Costs
Digestive Health Centers are independent ASCs, specializing in GI care and endoscopic procedures, in the North Texas area. All of our locations offer a seamless patient experience from scheduling to discharge, including pre-appointment confirmations, procedure preparation reminders, transparent pricing, friendly staff, short wait and procedure times, curbside drop-off and pick-up, and convenient parking. Every gastroenterologist is fellowship-trained, exceeding national benchmarks for quality of procedure performance, and supported by an expert staff that specializes in endoscopic care. Digestive Health Centers are CMS certified and AAAHC accredited, meaning the staff and facility must pass rigorous inspections to ensure that the highest level of safety and quality standards are upheld. Choosing an independent ASC is more than just a cost-effective option: it is top-quality care that you and your physician can trust. Contact us today for more information.
Health care is virtually the only service where the consumer is in the dark as to what it will cost. And that cost is increasingly shifting to you, the patient. Learn more about shopping for healthcare.