Health Savings Accounts: What The Physician Sees

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 [email protected].

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.