Of Planes and Patients
A criticism that’s often made about any form of government-regulated health care is that patients’ ability to choose will be limited. It’s not difficult to imagine this being an issue with ACOs, since in order to obtain the kind of coordinated care that HHS is calling for, patients will have to see a predetermined subset of clinicians. There’s been some talk in recent years about an upswing in patients selecting their own radiology providers, caused, in part, by escalating co-pays, which drive them to comparison-shop. But in a system dominated by ACOs, neither this cause nor its effect would occur. Is this good or bad for patients? I’m inclined to say “bad.” I’m an American; I like choices! In fact, I’ve stuck with my overpriced health insurance for years instead of switching to a cheaper HMO because I like my current doctors and don’t want to lose them. But then I saw this very funny video, “If Air Travel Worked Like Health Care.” If you don’t have time to watch it all, skip to the four-minute mark. This is where I really started thinking of radiology. The operator asks the customer if he has a preferred “fuelist.” When he, of course, answers that he doesn’t, she says, “We can make a fuel arrangement for you, but please be advised that the fuelist’s charge will be billed separately, and that you will be responsible for that.” A little bit later, he tells her that if this system worked more efficiently, “It would sell me a safe, round-trip journey instead of separate procedures.” It’s an apt metaphor. When we fly, we don’t get to choose personnel who’ll be ushering us to our destination. We don’t get to decide whether we’ll take a modern airplane with individual TV monitors for each seat or a heap of junk from the 70s that doesn’t even have room for our carry-on luggage. We’ve sacrificed choice, but what we get in return is a system that works remarkably well. All we have to do is show up with a driver’s license and next thing you know we’ve arrived where we wanted to be on the date we wanted to be there. We don’t control every little detail, but who would want to? As we move forward in developing more patient-centric ways of doing medicine, it’s important to remember that ease of access is everything to consumers. If we can make imaging a convenient, readily accessible component of a seamless health care process for patients, we’ll see the specialty thrive in a new way. Maybe patients won’t know or even think about what we do, the same way I rarely consider, say, a baggage handler’s role in getting me to my destination city. But is that such a bad thing? What do you think?