A recent Wall Street Journal expose details the concerning and widespread practice that is costing you money, and may be keeping you from the best care. With healthcare costs continuing to rise, we’ll show you how to avoid this industry trap and get access to the care you need – without wasting money.
It’s now been nearly a decade since Obamacare (Affordable Care Act) became law. Much has changed in healthcare over that period, including rising costs and provider consolidation. The Wall Street Journal article details how those rising costs may be a direct result of provider consolidation. To understand why the expansion of hospital systems might be costing you money, we’ll break down how the system works:
A hospital, seeking to expand its influence in a region begins buying local and independent imaging centers. Then, the hospital system begins to acquire primary care practices. In an area like Orlando, one detailed in the report, you might find nearly all the primary care doctors in the area are owned by a large system like Orlando Health. This allows health systems complete control over the the referral network – where your primary doctor sends you for specialty care. It also means the health system or hospital has complete control over the cost.
In this example, when you visit your doctor for something like back pain, you may not realize your doctor now works for Orlando Health. What’s more, you may not realize they are incentivized to refer you to a specialist within that Orlando Health network – likely a surgeon that also works for Orlando Health. That surgeon is often required to order MRI, CT, and other imaging services provided by that same hospital. These hospital owned diagnostic services are nearly always more expensive, and often cost more than twice as much as independent centers, for the exact same diagnostic service.
High cost aside, you’ve been referred to that surgeon simply because they’re in the hospital network and not because they have the best outcomes, or because they perform the latest minimally invasive techniques. In fact, you may find those same doctors, to whom the hospital incentivized your referral, are also financially incentivized to perform surgery at a higher rate than independent surgeons. After all, a hospital’s largest profit center is specialty surgery, like spine surgery.
The clever, and well engineered system is designed to maximize profit for the regional health system – NOT maximize your chances of getting the best care at the lowest cost. While you may not be able to avoid the health system in your area all together, here’s a few things you can do to ensure you get the right care, at the lowest cost, and don’t have unnecessary surgeries.
- ALWAYS get a second opinion. If you followed the recommendation of your primary care or pain doctor, it’s very likely you got sent to a specialist they were incentivized to refer you to.
- Always get an OBJECTIVE second opinion. Having your case reviewed by a specialist that is NOT in the network or region, and NOT financially incentivized to operate, is the only way to get a truly unbiased recommendation for the best treatment.
- ASK QUESTIONS about costs. Ask what the cost is for your MRI, X-ray, or CT. Then, call around to an independent imaging center who may offer the exact same scans at much lower rates. Ask your surgeon questions about their treatment plan, and what alternatives exist.
- DEMAND access to your diagnostic data. From MRIs to blood tests, those results are yours! You paid for those, have a right to access and send images and reports to anyone you choose. Keeping a record of your test results and images scans can help an objective, independent doctor recommend the best treatment, even if the consultation is done remotely.
The Wall Street Journal has done an excellent job exposing the hidden system of how doctor referrals work. Armed with this information, and confidence to ask questions or seek independent opinions, you can avoid overpaying, getting the wrong care, or having a bad outcome. If you have a WSJ subscription you can read the article here: https://www.wsj.com/articles/the-hidden-system-that-explains-how-your-doctor-makes-referrals-11545926166
If you’d like more information about independent virtual consults, please visit Second Opinion Spine, where a top-ranked team of spine surgeons are standing by to provide a completely objective and unbiased review of your case.