AF ablation Atrial fibrillation Health Care Health Care Reform

Comparison shopping for health-care?

Can a consumer (patient) really comparison shop for their health-care needs?

It seems there are entrepreneurs who want to help. Check the specifics at this website. It will not take long.

In this age of monopoly-money like health care charges, isn’t the notion of comparison shopping a joke?

Sure, you might find one doctor charges 10 or so dollars less for an office visit.  Or, maybe the Walgreens clinic will provide needless antibiotics for less than the Kroger clinic.

How would comparison shopping work in the field of heart rhythm management?

AF ablation at hospital A: 50,000 dollars.  AF ablation at hospital B: 40,000 dollars.  If your co-pay is 2000, does it really matter?  For hospital admissions involving ICDs, just add 25,000 more to the above.

Moreover, even if a company could tell a consumer that an ablation would be cheaper at Hospital C, how could they possibly know the inside scoop on a doctor’s skill in such a specialized procedure?

Take as an example, the patient I saw recently for AF consultation.  She saw a level-headed non-dabbling ablationist in town, who was less than enthusiastic about ablation. She then went to a “big-name” institution in the northern US, who told her, “yes, of course you should have ablation, we have done thousands…we will do it in 6 months.”  A few months before the ablation, the patient gets a letter, from the prestigious doctor at the famous institution, saying that he is moving back to his home country in the Middle East, and will be unavailable to do the ablation.  Hmm.  Her case was very complex, and I concurred with the humble local AF specialist; that ablation would clearly not be an easy journey, and that other tools might work better.

No worries though, comparative effectiveness research will sort all this out.  Yes sirree.

Medical complexity marches on, gone our the days of digoxin for AF, nitrates for angina, and diuretics for heart failure.

Patients want the best.  Government wants to provide care to all.  Not only, is the real cost of medicine–the 50,000$ ablation and 100,000$ ICD hospitalizations–ignored, the ability for consumers to know who is really the most capable practitioner is limited as well.

In health-care reform, we are at the base of the climb, for sure.


2 replies on “Comparison shopping for health-care?”

Perhaps one day there will be accountability in the care provided. Low performing facilities or MD's will lose priveleges for high complication or failure rates. I know this may lead to physicians cherry-picking procedures to pad numbers but procedures could be risk stratified to compensate. Do we really need 10 electropysiologists performing AF ablation if half are ineffecient or dare I suggest incompetent? Hospitals already receive reimbursement "bonuses" based on quality outcomes and some "not much to do with patient care" criteria (Magnet designation). It is only a matter of time before physicians become "preferred providers" by insurance companies rather than reserving that designation for facilities.

I wish for accountability measures nearly every day of my career. Branding doctors as preferred providers though, will be a dangerous concept, as to date, quality measures to select the best doctors fall far short. For insurance companies, or the State, it seems more likely that the preferred provider will be the one who uses the least amount of health-care expenditures in the near-term.

Also, unlike the thirty minute ICD implant, AF ablation in its current form, will not bring a rush of doctors to the table, as it is to hard. This is a good thing. But, as technology brings us tools like the cryo-balloon, which is marketed as making PVI easier, the financial attractiveness of AF ablation may improve. Not any time soon though.



Comments are closed.