“You’re charging me for what?” An affront to price transparency and health equity

As a patient I am often in disbelief at what I get billed by health systems. What’s worse is how hard it is to get a true accounting for what I’m being billed.

I’m ready for big stuff - surgeries, rehab, ED visits - because these things are typically overpriced due to myriad confounding factors, and I get that. 

But for me, what really gets me is the nickel and dime stuff.  

$10 for an aspirin.

$100 for a bag of saline. 

$35 for a message to my doctor on MyChart.

I bet that last one caught you off guard. 

It sure shocked me.  

When I read this article in Beckers last week, I had to do a double and then triple take, because I simply couldn’t believe it. 

Go, read the article (no, I’m not being paid by Beckers), I’ll wait.

Finished… good.

Trust me, like you I ran the emotional gauntlet that you are running right now: shock, disbelief, anger, incredulity, sadness, rage, and the depression that comes with the realization that the US healthcare system isn’t likely to get better any time soon.

I thought that price transparency was going to help with this.  Clearly not, or at least not yet.

I know that all signs point to an economic downturn.  

I know that hospital systems are struggling with revenue and bouncing back from the last nearly 3 years of COVID-Hell.  

I know that clinicians are struggling with balance and availability and burnout and reimbursement and myriad challenges.  

But charging to send messages on a platform designed to improve ease of use, access, and communication at a time when people are struggling to make time to take care of themselves.  It’s already hard enough to know when to go to the doc, when to go to the urgent care, when to go to the emergency room, and when to worry.  And now I have to worry about another bill, too.

That seems a bit egregious to me.  Ok, it’s not egregious, it’s ridiculous.  

Advocates of the move to charge for “consults” say that this is to ensure that providers are properly compensated for their time and that they don’t want to overcharge patients for simple asks.  

I get that.  I want providers and clinicians to get paid for work that they do.  I’m all for capitalism.

However, there’s no definitive line drawn as to what messages cost what nor when charges are assessed - you can imagine the billing, reimbursement, and recuperation nightmare, but that’s beside the point.

In the time of price transparency and health equity, this feels like a terrible move. As with most things, actions like this unfairly impact those patients who can’t make a trip to their doctor or to the clinic and may lead to further health disparities amongst poor and already struggling populations.

Frankly, this would keep me from messaging my PCP or anyone on my care team.  But maybe I’m being petty or cheap.

Without putting good, thoughtful, transparent governance around the pricing of messages, many patients of all demographics will be reluctant to reach out to their care team - furthering already large health disparities across the country.

If health systems really want to recession-proof their business and protect their providers, perhaps they should look at their own houses for improvement first.  

When we look at the current landscape of provider behavior, we see, on average, $500,000 worth of patients walking out the door (to competitors or worse, to no one) per provider, and those patients could be better managed and brought back in-house - to the benefit of BOTH the patient and the provider.

Think about that: $500,000 per provider, every year!

Half a million dollars.  Wow.  Not only does this give the system a nice revenue bump, but it makes the patient’s journey and the workload on the provider better. Keeping patients in house makes available their entire patient journey in the EHR, allowing providers to better manage care continuity, preventing loss to follow-up, and address health equity, something that ALL patients deserve.

It seems to me that this is a far more pragmatic solution than charging marginalized people (and non-marginalized people) $35 to ask their doctor a question.  

By improving processes and behaviors, more care is directly controlled by the provider and the patient, helping to recession-proof systems and helping to stem the iniquity of healthcare by orchestrating care journeys and better enabling those who are underserved and marginalized.

I humbly plead for us as a healthcare community to look toward internal improvements before off-loading the burden of inefficiency onto patients.