Your Patients Are Being Bled Dry

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Cat VaskoIn his Time magazine cover story, “Bitter Pill,” journalist Steven Brill dives into line-by-line analyses of patients’ hospital bills, breaking down exactly what they paid for which services. Even as a seven-year veteran of writing about our corner of the economy, I was appalled by what I read. To take a couple of examples at random, one patient was charged $39 for the reusable gown that his surgeon wore, while another was billed $8,000 for a CT stress test. The blame for this doesn’t lie at the feet of the imaging community, of course, nor does the article in any way suggest that it does. Nonetheless, I believe we all bear some responsibility for these atrocious and devastating bills in the sense that we currently take no responsibility for them. For all of our high-minded talk about outcomes and appropriateness, the financial burden we place on patients never seems to factor into our understanding of either. This is both a problem and an opportunity—because at the moment, no one on the clinical side is attempting to rectify the situation. The prevailing attitude is that the care is worth the cost, whatever it might be, but that’s a mindset left over from the halcyon days when many people were the beneficiaries of decent health plans. As a high-school student in the 1990s, well insulated by my parents’ insurance, I endured a spate of rule-out imaging studies on my path to the diagnosis of a kidney stone; I’d find that hilarious, were it not so tragic, compared with the decisions that I’d make today, with awareness of my stratospheric deductible ever foremost in my mind. Granted, there’s no shortage of shouting on the federal front about the criminal cost of care, but there’s a leadership vacuum on the clinical side; where there’s a leadership vacuum, there’s an opportunity for someone to be the hero. Wouldn’t it be fitting for imaging, the area so demonized for its contribution to escalating health-care costs, to step up and become that hero? Is there not a kind of poetic justice to the idea that those most unfairly reviled for their high-tech, high-ticket specialty would be the ones to take a leadership role in factoring economic impact into appropriateness and outcomes? This idea deserves our community’s consideration, especially at a time when we are struggling so mightily with how to become more patient-centered (in spite of the nature of our roles, which are fundamentally physician oriented). Demanding price transparency from the hospitals with which we work, taking on the task of calling payors to determine the exact dollar amounts with which our patients will be saddled, and establishing provider-side cost benchmarks based on what we need to be paid would be excellent starts. You might feel that this shouldn’t be imaging’s responsibility, and you are absolutely correct—in a fair world, it wouldn’t be. As Brill’s article makes abundantly clear, however, that’s the least of the injustices being perpetrated in health care right now. As long as everyone continues to abdicate responsibility, the opportunity will remain, waiting for the right hero to come along and take action.
Cat Vasko is editor of and associate editor of Radiology Business Journal.