Employers Avoid Unnecessary Spending, Give Employees Choices

On a daily basis, we all hear and see patients and families frustrated with the bad news of incurable cancer. The knee-jerk reaction is to surf the net or, worse yet, watch TV commercials looking for hope that is more promising than what reality dictates.

The reality is that medicine is a business, especially in large medical institutions where the bean counters set policies and economic mandates on their employees, including their physicians. The reaction to meet the mandate is overutilization to generate more revenue. Their job is on the line.

We have seen, on a regular basis, nationally-known cancer centers who repeat biopsies and imaging studies that either had been done a week before or are not needed because it would have a zero impact on the plan of attack. Patients are at their weakest point—vulnerable and trusting that a large institution is there only to help them. The fact is murkier than that.

A common scenario is to repeat a CAT scan because the doctor would claim that he could not open a file containing recent images on the CD or flash drive provided, or that the images are not clear, or, worse yet, that the quality of the image is “not up to par.” Not only does that justify the repeat test in the eyes of the patient, but also it leaves them with the dismay that the previously treating doctor was not competent, while the contrary could be the real truth.

The truth is, for a moment, there is satisfaction on the part of the patient because they feel that something extra, more detailed, and more accurate is being done. However, for the most part, the reality is that it has more to do with money than doing what is right.

How can an employer protect their employees from such abuse that borders on breaching the standard ethical conduct? You can’t, not even through elaborate education; but, ultimately, money talks.

We have learned that money is the strongest drive for patients to be more watchful and even skeptical. That drive vanishes when someone else is writing the check. Employers, such as LOWES and WalMart, figured out a medium that addresses the problem equitably. Employees can go wherever they want to go for medical care; but they have to incur some of the cost, if they choose a service entity that is known to be less cost conscious. However, if they choose to be treated at a designated, high-quality, cost-effective facility, their copay and out-of-pocket expenses are forgiven. This is a great strategy, since freedom of choice is maintained and honored, but at some cost, and rightly so. This policy in no way compromises quality care. Studies have consistently shown that the lower the cost, the better the quality of care and, certainly, vice versa. This is the basis for my book Good Medicine is Cheaper Medicine.

Employers have come to the conclusion that the health care industry in all its facets could care less about cost. Employees are vulnerable to media advertisements and Internet websites and employers have decided to take the lead in steering the society in the direction of better quality health care at a lower cost.