When “Transparency” Becomes a 4-Letter Word


Here’s a shocker. Just placed calls to local hospital billing centers requesting a list of self-pay prices for their basic diagnostic lab and imaging tests/procedures. One of them needs to speak to a supervisor and says they will get back to me. The other one apparently put me on hold to speak with a supervisor and came back telling me they flat-out can’t provide me a list, they can only give me prices for one test at a time. I asked to speak with the supervisor, got transferred and landed right in voicemail.

God forbid patients learn what they might have to pay before they go through with having something done to them.

We take this for granted nowadays for some reason: medical tests, procedures, or treatments get recommended with no regard for cost. Then patients get hit with a bill after the fact. Interestingly, this same situation happens with insurance companies (they get hit with the bill after tests have been ordered or complete) and guess what, they don’t like it either! So they compensate by cranking premiums and deductibles.

I’ve heard some great analogies for how this system is positively ridiculous: It’s like going to a department store, being told you can get whatever you want off the shelves — but there are no price tags — then getting a bill in the mail 3 weeks later. Or like going to a restaurant, being told you can eat whatever you’d like off the menu — again, prices not listed – and also getting billed weeks or months later for the meal.  It’s pretty hard to make responsible decisions based on value when the measure of value is not even presented to make it part of the decision-making equation.  The most fascinating part?  Not even the salespeople or at the department store or the waitstaff or even the chefs at the restaurant know what the prices are!!!  They just churn through their jobs of assisting customers and diners to obtain what they need or want.  Meanwhile the folks who send bills are in a completely different building, possibly a whole different town.  They don’t see customers at the racks or shelves, they don’t meet diners during their meals, they only see names and numbers on paper.  This makes it easy to send out bills then feel indignant when the people who were never given any opportunity to anticipate the cost don’t pay the eye-popping prices long after the fact.

I mean, why even bother drawing analogies?  The reality itself is ridiculous, plain and simple.  What we need is TRANSPARENCY.  Is it more asinine to expect knowledge of cost before something is purchased, or to shirk at the folks who seek it?  It seems quite possible that my request for price lists is about to get shirked.  When “transparency” is treated like a four-letter word, that should be a mark that something has gone horribly wrong in a culture.  Is that how we want to be known in our country?  We are the nation that can’t manage our dealings with one another unless we are sneaky, underhanded and “getting over”??  Please tell me that is not who we are!

Maybe some of us are done with that.  We put our money where our mouths are to make it work and get it right.  We take a pay cut to be able to invest enough time to take pride in our craft and not treat our clientele like the enemy but to do our jobs with integrity and compassion.  Hey, granted: not everyone can afford to step away from a steady income to participate in a movement aimed at changing a broken culture.  My own participation is something I definitely count a blessing.  But all I ask is that those who recognize where things are broken stop defending it.  Consider carefully where you stand, and take a moment to spread the word to people who may not know there are alternatives.  This is the nation where we can and have and should continue to identify injustices and promote change to make things right.

We’ll see if either of these billing departments get back to me.  In the meantime, if you’re curious about getting health care that is not shrouded in mystery and backdoor finagling, look into Direct Primary Care.  No lie: it is a movement that will not stay afloat unless there are patients willing to unplug from the Matrix and get real.  But the fact is that it is not a cash cow.  Those of us doing this simply seek to regain our dignity as providers of care, to heal and help, to promote well-being, rather than churn out numbers to feed the machine.  The more we shift care in this direction, the more doctors in training will choose it as it is a way to do primary care and general practice that actually yields professional satisfaction, which has otherwise become all but lost in this field.  This is why doctors are exiting primary care in droves, necessitating more urgent care and “gatekeeping” instead of practicing medicine.

Instead, let me tell you about my recent experience kicking off my DPC practice:  I have started home visits!  Tomorrow will complete my first two weeks of seeing patients in their own environments which has been joyously eye-opening.  Patients who are normally anxious, uncomfortable, and apprehensive at the doctor’s office where they feel like and are often treated like a number — these same folks are calm and relaxed in their own home and work environments — imagine that.  Blood pressures are much better controlled; that’s been a simple and pleasant measurable outcome. And because I treat them, their homes and their families with respect, they show respect in return and express far more determination to take control of their own care.  I have not spoken with a single patient during these visits who actually wants more medication.  No one wants more pills.  Everyone just wants to get better, and until now medication is the only thing the doctors have offered.  Now they get support, encouragement, and sometimes even tough love.  Guess what: all of that takes time.  They have found a doctor who is willing to give them the time.

We believe: “The good physician treats the disease.  The great physician treats the patient who has the disease.” (Sir William Osler)

Okay.  Rant over.

Learn more about Direct Primary Care through Thrive APC, and Direct Primary Care in New England.

Learn more about my new practice, Thrive Adult Primary Care.  Feel free to browse around the website.  If you want experience a better health care experience, click here to learn how to become a patient.  Home visits will resume starting September 4, 2017, until the office opens!  When that happens, feel free to drop by and learn more.  See you on the other side.