Healthcare and Money

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One afternoon in the ER I entered the room to evaluate a 6 yo girl with a fever and vomiting, and I asked her mother how she was doing. The mother seemed concerned, but not in the way of many families, she was concerned in a different way.  In a defeated tone she stated that she was “starting to have a very expensive day.” So I asked her what it was that made her day so expensive?  The mom’s greatest concern was the expense that she would incur just by walking through the doors of the emergency room.  This mom was not one to frequent the ER, but only after all other attempts at home treatment had failed, including a call to her doctor. In this case the long blond-haired child looked mildly ill and mildly dehydrated, but she was interactive, not actively vomiting and the fever was coming down.  So I spoke to mom about our options. The first option was more invasive and costly with IV therapy, but could save some time.  The more conservative, more affordable option would be an oral nausea medication and oral rehydration, but this would take much more time.   In the ER doctors don’t have great control over the basic bill, but of course more testing and more invasive treatments typically mean a much greater charge.  In comparison, in Urgent Care, we have much more control of costs and patients can know how much they are spending up front, eliminating that concern from their list. So we took the conservative approach and treated the patient for vomiting with a dissolvable tablet, further treated her fever and attempted slow oral rehydration. In the end, after a few hours, the child looked even better, had tolerated a good amount of fluid intake and had tolerated antibiotics (for a bladder infection).  The mother was happy that no IV had to be started and that likely no great expense would be incurred.  She was also especially relieved that her daughter was looking well and we had come to a treatment plan together. It is unfortunate that patients and families have the fear of very high cost experience associated with what may not be a life-threatening illness, however, that should not be a barrier to them seeking care. It is excellent however to be able to get people’s greatest concern out on the table right away so that we can discuss the primary concerns and different options.  There are always options. 9 ways to avoid a “very expensive day” with illness

  • Let your concerns be known up front – we all have limited time and money, in addition to our concerns of illness.  Let your provider know your concerns up front.  ie.  “I am only here to make sure that I do not have a brain tumor”, is better to know than looking for a new doctor to “cure” your daily headaches.
  • Be involved in your care – question especially expensive testing if you don’t understand the rationale.  There are always options, but you may need to be an active participant to find them out.
  • Bring a friend.  In case you are too ill to be so involved in your care, a friend or family will be your advocate and can ask the appropriate questions and remember the answers so that the same tests need not be repeated later.
  • Stay healthy – Avoiding excessive alcohol, and getting enough exercise and sleep will go a long way in preventing many acute (potentially expensive) illnesses.
  • Control your chronic disease – most patients who spend a long time in the hospital, and therefore a lot of money, are usually admitted due to a chronic disease that could have been managed better.  Recognize the signs of minor worsening and seek care sooner.  By the time you need emergency care, it’s too late.
  • Don’t wait until the last minute to seek care.  I recently saw a previously healthy 80-ish female who was visiting from overseas and had been having dark stools and worsening weakness for 2 months.  She only sought care when she had to be carried up the stairs and couldn’t walk 3 steps without losing her breath.  She had been bleeding slowly in her intestine and would need at least 3 units of blood transfused to get her to ½ of a normal blood level.  Transfusions are some of the most expensive treatments we have, and this could have been avoided.
  • Ask for more affordable prescriptions – I will often ask my patients if they have a prescription plan if I am prescribing a medication that has affordable alternatives (and most do).  Most expensive acute medications can be replaced by generic ones that can be found at Walmart for $4, which are just as effective, but may require taking more pills more often than the expensive options.
  • Follow the treatment and follow-up plan – Many patients who have to return for expensive re-evaluations for the same illness, and often later require admission, have not followed up with their doctors and some have not taken medications as prescribed. Also it is better to at least follow up with your doctor and admit that you have not been taking your medication, so you can work on a new plan together, than to not follow up at all.
  • Seek more affordable treatment options (earlier) – options such as a primary care doctor or a quality Urgent Care can save you a lot of tests, time and money, assuming you have not advanced too far with your illness.

In this case, this child could have received the same treatment in a Quality Urgent Care center, such as Connecticut Urgent Care Centers (CUCC), where the caregivers are skilled at treating sick kids and have much more control over the costs.  ED doctors do our best to control costs when possible for the patients, but inevitably, costs for this sort of care would be 3-10 x as great in the ED. I am proud to be a part of CUCC where we can make a difference in health care costs and access and be a reasonable option for so many who are ready to be more involved in their care.

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