One result of these missed opportunities in responsibility and pricing can be demonstrated in the issue of surprise billing. For emergency and scheduled inpatient care, a widespread and costly problem is when a patient receives an unexpected bill for medical services with no opportunity to make an informed consent of the provider, and no disclosure is given before the service. The HHS Secretary’s report (2020) indicates a 41% incident rate of the last two years of a received surprise, and approximately half of them reported it was due to an out-of-network (OON) provider.
Patients must be able to make informed decisions, especially when vulnerable, related to such specialists as anesthesiologists or pathologists because they are not in the delivery of care model with ACA. Federal legislation is needed to protect all patients on a consistent and comprehensive basis, and outline how to make the charges public and accessible. (HHS Secretary’s Report, 2020).
Healthcare will evolve into three paths. Incentives tools to stay healthy for the patient, provider tools to keep patients healthy, and creating and sustaining integrated healthcare to maintain the health of the whole person (Custer, 2016). Money spent is money that is now lost. Because the healthcare facilities were private and the health insurance payers are increasingly public, amid the most expensive healthcare in the world (and best), increased spending is inevitable unless contained. Again, we are at the most expensive per capita and the highest percentage GDP spending apex. The findings outlined show why.
References Custer, W. S. (2016). Health Care Cost Inflation in the Next Decade. Journal of Financial Service Professionals, 70(1), 37–39. https://search-ebscohost-com.proxy1.ncu.edu/login.aspx?direct=true&db=bth&AN=111743162&site=eds-live Fitzpatrick, T., Rosella, L. C., Calzavara, A., Petch, J., Pinto, A. D., Manson, H., . . . Wodchis, W. P. (2015). Looking Beyond Income and Education. American Journal of Preventive Medicine, 49(2), 161-171. doi:10.1016/j.amepre.2015.02.018 Hall, A. (2014). Financial $ide Effects: Why Patients Should Be Informed of Costs. Hastings Center Report, 44(3), 41–47. https://doi-org.proxy1.ncu.edu/10.1002/hast.312 HHS Secretary’s Report on: Addressing Surprise Medical Billing (2020, July 29). Retrieved July 28, 2020, from 2020. https://HHS Secretary’s Report.hhs.gov/ Sabbatini, A.K., Tilburt, J.C., Campbell, E.G. et al. (2014). Controlling Health Costs: Physician Responses to Patient Expectations for Medical Care. J GEN INTERN MED 29, 1234–1241. https://doi-org.proxy1.ncu.edu/10.1007/s11606-014-2898-6
Strategies for Physicians
A. Educate Patients: Range in depth, but when it comes to cost discussion does result in increased responsibility. B. Build trust: Mostly will alleviate anxiety, and in that increased trust even more. C. Substitute: When considering a less costly alternative, or deferral strategies, substitution can be successful.