Tuesday, May 29, 2007

My Mechanic vs My Doctor

My mechanic is a great guy, I've been using the same guy for years now. Not only is he up front about what's needed, what's not, and how much it will all cost, but he drives the exact same car as me. This very morning, after hitting a pothole this weekend, I dropped my car off and described the excitingly new squeaking and clunking emanating from the left hand front wheel well. He calls me within the hour to confirm his suspicions: I broke a stabilizer rod, the very same thing happenend to him only two weeks ago and helped him diagnose my problem.

Listening to NPR this weekend, I was interested to hear my favourite finance news show cover the news about a doctor's group in California publishing the prices they charge for common office -based procedures such as EKGs, vaccinations etc. A brief point counter-point ensued wherein a pro-transparency lass made a statement about how great pricing transparency is and someone else who doesn't think so said so, stating:

"Shopping for a doctor is not shopping for procedures, it's shopping for a person, someone you can trust, who understands your priorities, someone you can develop a relationship with".

Hence, the logic seemed to be, price doesn't matter.

I got to thinking about my trusted mechanic. I didn't shop for him by price. He came highly recommended and I grew to trust him after a few visits. He may not be aware of it, but I'll drive the 20 miles from home to drop the car off for the day.

Nonetheless, once the trust has been established and the relationship built, what possible reason is there for him to say "now that you trust me, I have no need whatsoever to allow you to remain confident that I am not gouging you, that I am competitive with my rates, or at least you are only paying a small premium to continue a trusted relationship".

No, in fact, whenever I drop my car off, he calls me before commencing any work. Tells me what parts I'll need, how fast he can get them, how much they'll cost, how much the labour will be. I get a full and detailed price estimate before any work begins.

Of course, I don't have an automobile HMO. If I were as divorced from my car maintenance payments as I am from my medical bills, he might be extremely willing to perform as much work, necessary or otherwise, on my car, and file for reimbursement. But no, he knows full well I have limited means, I want the car to run but not be in tip top as-new condition, I'm about function over form and he has *never* offered to pull the dents out of the car.

I agree whole-heartedly; shopping for a doctor is not about price, it's about a personal relationship. And like any good relationship, I like to review all the costs; spiritual, emtional, ethical and fiscal. Doctors and health care are not above the money. If they were, we'd all be getting free health care and the docs would be in bread lines, but in fact they make an average six-figure salary and many grumble it's not enough, so quit with the line that it's not about the money. We all want to get paid, doctors and mechanics included.

As the US veers into shifting some of the cost burden back where it belongs - the customer - price transparency has to become the norm. Health care is a business much like any other, it's not so special. Sure, it's a calling. So is software development. So is ministering. We all get paid.


I heard a story this weekend about a doc who offered to perform a muscular biopsy in the office for a nominal fee of roughly a hundred dollars. The patient called in for pre-authorization and the HMO responded that they would only cover it in a hospital. The patient duly made an appointment and received a bill for a couple of thousand dollars, the co-pay on a $20,000 bill.

The doc took it upon himself to call the HMO and call them out for being idiots, although who knows what actuarial rules were at play, but nonetheless, we need more docs like this looking out for both the patient *and* the bottom line; customer service and the price thereof are all part of doing business and private practice docs especially are - am0ng other things - small businessmen just like your local accountant or your local mechanic.

Bring the customers in, perform a good, quality service and charge a competitive rate. That's all we ask.

I can't speak to the accuracy of the numbers above, but this and similar events occur all the time, part of a system where the money is so divorced from the consumer it's like trying to dig up information on the Illuminati.

So, in short, I applaud the California doctors and I eagerly await news of more like-minded practices.

And if you have a crazy hospital bill story to share, please do.


One final note, more of a note to self really.

Why do doctor's customers get called "patients"? I'm not his patient. Maybe if I'm in a hospital and I have to stay there then maybe I'm a patient, but a doctor I see maybe once a year? The only patient-ness I exhibit is the two hours waiting until 3pm for my 1pm appointment. Stop calling me a patient. Other professionals call me a client. Anyone else agree?


Eric Carroll said...

Preach on Brother!

Man you've got me all fired up... all of this is very clearly and intelligently written, but I am especially taken by your first story/anaolgy.

Disclosures and Disclaimers


My employer is compensated through funding to provide analytical research, technology solutions, and Web-based public and private health care performance reports by the State of New York, the State of Illinois, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Commonwealth Fund and Bridges to Excellence. I am not being compensated by any of these organisations to create articles for or make edits to this Web site or any other medium; and all posts authored by me are as an individual and do not represent my employer or the agencies I work for.