Doctors Are Increasing Medical Bills: How You Can Stop It

BY BEN CONNER

The doctors your employees visit are often the wrong choice for their health and their finances. In Indiana, for example, 80% of doctors work inside a hospital system. When they have to refer a patient to another physician, they’re required to refer within their own system without any sort of independent review. Patients are then stuck with lower-quality doctors, which means they will require more time to recover from their illnesses. This is bad news for health care costs, and it is bad news for the employer offering health benefits. 

To be fair, part of the problem is the consumers themselves. When we are in the market for a new doctor, we trust that whoever we visit will make us healthy, but we rarely spend time vetting our options. Compare this to our other shopping behaviors. When we buy a new TV, we spend hours scouring reviews. When we need gas, we’ll drive out of our way to find the cheapest prices. But when it comes to a surgeon, we settle for whomever our doctor recommends. 

Failure to find the best doctor can prove costly, both for your employees and health insurance premiums. If an employee entrusts their knee replacement to a poorly-rated surgeon, they may encounter additional expenses in unexpected places:

• Workplace productivity may decline, especially if mobility is important on the job.
• They may need a second surgery to correct the first surgery.
• Their physical therapy regimen may become more difficult and more time-intensive.
• They may need to be on extra medication for a longer period of time as their body heals. 

Each issue compounds the others. As a result, insurance has to cover larger health care bills, and those costs are pushed back to your company and the employee.

Bad Surgeons in Action

We explained this conundrum in a recent meeting with a prospect. As we were leaving the meeting, the prospect asked us to review two individual surgeons. One of his employees had recently undergone emergency surgery, and the surgery went so poorly, it had to be followed up by a second surgery performed by a different doctor. But the second surgery failed to make life easier for the employee. The employee was still in pain, she had trouble working, and she was on a long list of painkillers and medications. 

Once we were back in the office, we had our Medical Management Team investigate the two doctors. They scoured through the available data and examined factors like patient mortality, patient complications, patient readmission, and patient safety. On a scale of 0-100 (with 100 being the best possible score), the first surgeon scored a mere 39.1 points. The second surgeon scored 42.9. When we sent over the statistics, we also included another piece of data we uncovered in our research: the names of two nearby doctors in the same medical category who scored 99.6 and 94.7.

If the original surgery had been performed by the surgeon who scored 99.6, how would the employee’s quality of life be different now? How much money could have been saved for both the business and the employee’s family? While many factors influence the success of surgery, we can assume the employee would be in less pain and taking fewer medications if she had received surgery from one of the better doctors. 

When we design plans for our customers, we use this same physician data. Instead of pushing our customers to rely on in-network doctors, we actively search for the best care available. Although better care is often more expensive up front, the savings occur in the long run. A better surgery means reduced recovery time, less money spent on medications, and less time in physical therapy.