Recently, I had the unfortunate opportunity to experience a healthcare encounter first hand. Though I wish it could have been avoided, I immediately noticed several significant differences compared to other experiences of my past. Not long ago, on my blog, I wrote about shared decision making, pricing transparency, and the opioid situation of prescribing narcotics when not always needed or desired. As luck would have it, I experienced all three at once in one fell swoop.
A few weeks ago, while on a ski vacation, I took a bit of a tumble, and consequently landed in a clinic at the bottom of the mountain that was owned and operated by the local healthcare system. As one can imagine, it was jam-packed with various orthopedic injuries, including yours truly. Because of the design of the clinic, and the nature of my visit, I was able to observe and partake in numerous conversations. As would be expected, the care was excellent, but the discussions were markedly different than those I have encountered in the past. Since all patients “visiting” the clinic were either on a high deductible health plan or being seen out of their tier 1 network, patients were asking about the cost of service. Even more interesting were the responses that were given. Occurring throughout were several frank conversations with the physicians who knew how to respond to concerned patients’ questions. Using this same direct method they discussed my medical condition, and concurrently responded to my questions concerning my options of care and the costs involved with each of those possibilities.
From these conversations, we came to shared decisions on what level of x-rays I required as well as how to best treat my pain. Since I requested not to receive narcotics, I was given multiple options in how to cope with my pain. For instance, because I needed a muscle relaxer, my choices included a single dose dispensed as part of my treatment, a prescription that could be filled by them allowing me to take my “own” pill, or a prescription that I would fill elsewhere. Each option came with a predicted cost.
Throughout my stay, I observed numerous, similar conversations, and most remarkable was the fluency of the discussions and the varied choices made by the patients. At no time did I feel sub-optimal care was transpiring. Furthermore, as part of my acute treatment, I was referred to a physical therapy department within the same location owned by a different entity. Upon my arrival, the physical therapist immediately apologized for being out of network as a result from the recent change of ownership. Then, he quoted me a cash price for the treatment prescribed. When I reminded him that two treatments were required, he cheerfully offered both for the same price. Since I felt the price was reasonable for the expected outcome, I paid it with my Health Savings Account card.
Upon discharge, several survey questions were presented to me, of which one was “how well was my pain being addressed?” Despite having selected a treatment option which did not alleviate my moderately severe pain at that moment, I responded in the affirmative as my pain had been addressed in a manner that allowed me to share in the decision.
Times are changing. Contrary to how I have felt in the past, I left there understanding the cost implications of my choices, feeling that I participated in my health options and that I received excellent care. Including me in the treatment process and allowing me to be part of the solution required more time and effort from the physicians, but left me believing I received better global care. I felt that value was delivered through high quality care, high engagement, and open conversations concerning all my fears, including price and overuse of opioids. Though I am still recovering from my injury, I undoubtedly feel we are making progress in how healthcare conversations are evolving.