ADC Website Fee-for-Service

The Fee-for-Service Nightmare

Our team at Assured Direct Care recently attended a Hint Summit where we had the opportunity to hear from many key leaders in health care reform. Even though COVID required us to participate virtually, we came away inspired to continue our work to make health care more affordable and responsive to the needs or our patients.

As I was catching up on my charting this past Saturday, I ran across a perfect example of how dysfunctional our fee for service model has become. An outside note I reviewed for a hormone injection showed a simple procedure billed out to Medicare at $17. The real cost of the shot is about $3 for the medication, $0.25 for the syringe, and $1 for the 2 minutes it took the staff to give the shot and enter a note in the computer.

The patient was asked to sign an Advance Beneficiary Notice:
You may be asked to pay now but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare does not pay, I am responsible for the payment, but I can appeal to Medicare per the instructions on the MSN. If Medicare does pay then we will refund any payment made to you, minus the co-pays or deductibles.

Now I am a doctor and I am confused; and all this just for a $5 injection! It powerfully demonstrates why patients are frustrated and confused, doctors are leaving the profession, and why health care is so expensive. What other business can mark up its products over 200% and be so unclear what the price we will end up paying?

It is estimated that up to 40% of health care dollars are spent billing third parties in our fee for service approach. Some estimate that 20% of medical care in our country us unnecessary. What could we do for those without coverage if we just cut 25% of this unnecessary spend? But it is clear to me that we cannot wait for the government or hospital systems to fix this broken ship. We all need to become better consumers of health care and stop assuming someone else is paying the bill. A per member per month payment model like Direct Care is the solution we need to simplify our health care system and make it more patient friendly and much more affordable. My next blog will discuss the big picture of health care spending and what really impacts the health of our community.

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