Health Savings Accounts: What The Physician Sees

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As a benefits broker youre ready to sell Health Savings Accounts and your clients are ready to offer HSAs to their employees. Is the health care system ready to support success with HSAs?

I reflect back on the conversations I had with my patients as we discussed the operation I was going to perform. I wonder how well the early adopters of HSAs will fare.

Im optimistic about the power of HSAs to lower escalating business health care costs. The reason is simple. When employees experience the consequences of their choices, they can and will make good decisions. They will collect information about cost and quality and make informed choices based on value.

But try to figure out where to get your hernia fixed and youll discover how far we have to go. Sadly, asking consumers to drive their health plans is like asking blind people to become NASCAR drivers.

Its virtually impossible to compare health care costs. There are some legitimate reasons. Asking, “What will it cost to get my hernia repaired?” is like asking, “What will a 2-week trip to France cost?” It depends on what kind of journey you make. However, you can easily compare the costs for a 10-day cruise to Alaska on three different cruise lines.

Its almost impossible to do the same with a medical procedure, and heres why. Health care, like any other business, is subject to antitrust regulation to avoid monopolies. This has created a veil of secrecy about professional medical fees.

When I set up my surgical practice in the pre-managed care era, I could not just go to a colleague and ask, “What do you charge to remove a gallbladder?” You can see the potential for this discussion to lead to price-fixing.

When I became a provider in a managed care plan, my patients and I knew what my fee was and what their out-of-pocket expenses would be for a procedure like an appendectomy. If you called my office and asked, “How much is an appendectomy?” the answer would still be, “It depends.”

My surgical fees for an appendectomy varied by a factor of 6, depending on the patients insurance coverage. We must shape policy so employees and their doctors can talk about costs. We must change the culture so employees and their doctors will talk about costs.

How do you compare quality and get a report card for the doctor and the hospital? First, you want to compare the patients outcomes from doctor to doctor. For hernia repair, the most important question is, “How often do your patients hernias recur?” Where do you go to find the right questions? Where do you go to get the answers? Second, you want to compare the patients experience, which is highly variable even between patients who get perfect outcomes. Where is the patient satisfaction data?

From people like brokers who are on the front line, I hear that the early adopters are pleased with HSAs and their results.

Getting from where we are to a system that supports HSA success will be a bumpy ride. And its well worth it. Transparency of medical costs and availability of information about quality of care will help all of your clients.

Its worth pushing forward, because heres the best news about HSAs: They place responsibility for health-related choices firmly on the shoulders of the people who live with their consequences.

, M.D., is president of Medical Bridges, Bellevue, Wash. She is a board-certified surgeon who left the operating room to help employees become active participants in their health care. She can be reached at DrRackner@MedicalBridges.com.


Reproduced from National Underwriter Edition, January 6, 2005. Copyright 2005 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.