Helping make the health care system work for you

Cedars-Sinai uses electronic records to spur improved, lower cost care

Jay Reed via Flickr Creative Commons

Last week, I told you about Sutter Health's efforts to orient its doctors toward more cost-conscious, high-quality care.

As you might remember, the Northern California health system is gathering doctors and, using data culled from electronic health records, comparing individual doctors' practice patterns. It's an attempt to get doctors to change their behavior by exposing them to their peers' success at providing high quality care at a lower cost. 

Today, I have another cool model to share!

Cedars-Sinai Health System in Los Angeles has chosen another route toward higher-quality, lower-cost care: It's incorporated a set of best-practice guidelines into its electronic health system. Essentially, the system alerts physicians when they attempt to order a procedure or medication that could be unnecessary or harmful. This often spurs them to reconsider their decisions, according to Cedars officials.

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What doctors and patients can learn from accountants and veterinarians

Rebecca Plevin/KPCC

Dr. Diane Tang, of Mohawk Alley Animal Hospital, examines Melvin.

Here at Impatient, we've been exploring why doctors and patients don't often discuss the costs of health care. I've also been offering tips on how both can play a role in making these conversations a part of routine care.

But this concept of discussing costs in the exam room is still foreign to a lot of people. So today, for a radio story that's airing on KPCC, I provide examples of situations where these types of cost-related discussions occur more frequently.

'A great investment'

My search for models for better conversations about health costs brought me to the Hollywood office of accountant Persida Matei.

She says she asks her clients a lot of questions when she first starts working with them. Questions, she says, like, "are you married? Do you have children? What is your age? What is your tolerance to risk?"

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Nearly 1 in 4 Californians hit by surprise medical bills

Becky Wetherington via Flickr Creative Commons

KPCC is collaborating with KQED as we explore issues of cost and transparency in health care. Here's a great article from my colleague Lisa Aliferis, who writes and edits KQED's State of Health blog.

Over the past two years almost one in four Californians with private health insurance received a surprise medical bill — a bill where the insurer paid less than expected — according to a survey from the Consumer Reports National Research Center.

Of those consumers who had been hospitalized or went to an emergency department, 23 percent were charged an out-of-network rate when they had thought the doctor was in-network.

"This is one of the big loopholes in the health insurance system that perpetuates the bill shock that consumers are facing," said Betsy Imholz of Consumers Union in San Francisco who oversaw analysis of the California survey results. "It really puts consumers in the middle of the battle between insurance providers and out-of-network doctors in particular."

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Health Highlights: Doctors lower costs, the measles vaccine's hidden powers, a surprise about narrow networks

Keoni Cabral via Flickr Creative Commons

This week's top consumer health stories will make you rethink how you approach health care: Are narrow provider networks really so bad? And could the measles vaccine be preventing childhood deaths from other diseases? Plus, find out what it’s like to be a journalist with autism.

Showing doctors the way to lower cost, improved care

In a post this week for Impatient, I write that convincing doctors to avoid ordering unnecessary tests, or avoid prescribing expensive brand name drugs when generic versions are available, will require a larger, cultural shift in health care.

Sutter Health, a health system in Northern California, has developed a way to concretely change physicians' behavior. Could this be a model for a cultural shift toward more cost-conscious, high-quality care? I also discussed this topic on Take Two.

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Showing doctors the way to lower cost, improved care

Mercer 6983

Joe Raedle/Getty Images

As regular readers of Impatient know, I've been on a mission recently to encourage consumers to talk with their doctors about health care costs.

Everyone I've spoken with for this series - patients on high-deductible health plans, patient advocates and a few doctors - agrees that through these conversations, patients and doctors can work together to potentially lower people's out-of-pocket costs.

But as Duke University professor Peter Ubel points out, patients can only have so much influence over their doctors' recommendations.

"One of the biggest limits to the power of health care consumerism - of patients to discipline the health care marketplace - is the fact that doctors make most of the medical decisions," Ubel tells me.

He offers this example:  If a patient goes to see a doctor for back pain, and the doctor recommends an MRI, the patient can shop around for the most affordable MRI. But, he says, "I, as a patient, might not know that I didn't need any MRI."

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