Brian Klepper
Posted 9/21/14 on the NBCH Newsletter Blog
In today’s New York Times, Elizabeth Rosenthal describes the growing and egregious over-treatment and overpricing practices by physicians and health systems, abetted by health plans.
The excesses detailed in this article are at the core of our national health care quality and cost crisis. The best solutions are collaborative, considered actions by group purchasers, potentially the most empowered of health care’s stakeholders.
When predatory anecdotes like these come to light, the benefits managers – or better yet, the CFOs – of local employers, unions and governmental agencies should immediately call the health plan and demand that the health systems, physicians and other providers involved be removed from the provider panel. (Small communities held hostage by a few dominant health care players are a separate topic that I’ll address soon.)
As Tom Emerick, former VP Human Resources at Walmart has stated repeatedly, health care will not improve until purchasers demand different behaviors from health care vendors, focusing business on organizations that facilitate high quality care at reasonable cost, and publicly avoiding those that do not.
This is a serious issue that demands a coordinated response. It is at the top of NBCH’s agenda. Join with us on this.
Brian Klepper is the CEO of the National Business Coalition on Health.
Care And Cost 
“Predatory health care”. What an interesting concept. Although I hadn’t thought of it in that way, I think you are right, Brian.
Very interesting post. Yes you are quite correct. I’ve had problems and only 1 time has the insurance gone and asked the doctor why they were doing what they were doing. No rhyme or reason to the heath care they paid for.
It’s amazing what some people will do to make a buck — this is a new low for doctors — asking another surgeon to participate in surgery without the patient’s consent. To say it was a situation that needed urgent attention is a joke since the operation was probably on the assisting surgeon’s schedule for weeks. Every patient should now demand to know who will be involved in surgery and insist only in-network providers be involved. Alternatively, state regulations could require assisting surgeons to bill the primary surgeon rather than the patient (that would stop the practice immediately).
I like your idea of having to bill the primary surgeon. You are right — that would be the end of that.
Rosenthal points to a big problem – but the abuse of process also occurs at the edges – smaller – but still wrong abuses. My wife recently had to go to a local walk in clinic. After running virtually every test they were capable of running and billing our provider for, they decided they need to send her to the ER at the nearby hospital. All of the documents/tests were given to her and I at thought, well at least that part is over and we should get a diagnosis quicker. WRONG – upon arrival at the ER the admitting Doc refused to even look at the prior tests and ordered a new round of the same exact tests. Our insurance covered both the original and duplicate tests – but this is a waste of time and dollars that I suspect happens more often than not. Patients – and their spouses are not really in a position to object – so the Docs/hospitals get wealthy at our expense.
COO of Sonrise Health Co-op Thank You Brian good reading
You’re right about the expense of Long Term Care. It isn’t for everybody, but if estate preservation is a goal, it’s a way to transfer that risk elsewhere.
However, complex systems are typically conservative and rather resistant to change, and the healthcare system is no exception to this rule. The challenge is that doctors have to be central players in the healthcare revolution and any strategy that they do not embrace will fail. Certainly, a piecemeal approach will not work. Engaging doctors in transforming the system requires focusing on shared goals, by using motivational tools: shared purpose, peer pressure, measuring performance, and enhancing a patient-centered approach.