What a tupelo branch can teach us about healthcare consumerism
A few Saturdays ago, I was out doing some yardwork and eyed a high limb on our tupelo tree that needed to be removed. I happened to have a 10-foot step ladder and telescopic pruning saw handy. Next, I caught myself standing at the top of the ladder sawing away. Of course, the limb proceeded to fall on my head.
Like I often say, I’m good at benefits consulting but not much else.
Fortunately, I wasn’t hurt and climbed down the ladder and began dragging the limb off into the woods. It was then that I noticed the blood dripping off my forehead. So, I quickly strolled up our back deck, opened the screen door and asked my wife to bring me a few paper towels.
“Sure, but what do you need paper towels for?” she asked, walking over from her office.
“Oh, no reason, really. . .” I sheepishly replied.
Isn’t the worst thing about doing something foolish getting caught, especially by your spouse?
Upon seeing my face, she exclaimed, “Oh, honey, what have you done to yourself this time? Let’s get you to the emergency room!”
As I applied the paper towels to my forehead, I mustered, “It’s just a scrape; I’ll be fine. Plus, you know how expensive the emergency room can be.”
However, after a few minutes of self-care featuring some warm water, a washcloth and a bottle of hydrogen peroxide, it became clear that while my injury wasn’t a true emergency, I was in need of a few stitches. Thus, my wife again offered to drive me to the emergency room. But, as a benefits professional, I knew that if I could secure the needed attention at an urgent care facility; my cost and the cost of my employer (our high deductible health plan is self-funded) would be much less.
Kindly, my wife called the nearest urgent care facility and confirmed that they could stitch me up. Upon arriving, the registration process was quick, the wait wasn’t long, and in a crazy coincidence, my next-door neighbor was my nurse (so much for keeping this episode a secret).
When the physician arrived, everything went along swimmingly, until he discovered that a thick splinter from the tupelo was wedged into my scalp. But, as we casually discussed the increasing costs of specialty medications, he extracted the splinter, stitched me up and sent me on my way. The facility billed $270 for the procedure and $65 for the Saturday office visit. After the network discount was applied, the costs became $110 and $25, respectively. Thus, my out-of-pocket expense was only $135. Isn’t that a remarkably low price given the value of the service and its timeliness?
What would the costs have been for this procedure at the emergency room? Our health plan’s cost-estimator tool reports that the average cost of an ER visit in my area is $1,300. But, given the varying procedures performed at the ER, we know that the deviation from this average can be considerable.
When it came time to remove the stitches, instead of making the longer drive back to the urgent care facility, I scheduled an appointment with my nearby primary care physician. It took him less than 30 seconds to remove the stitches. Nonetheless, the visit was coded as a regular office visit and, after network discounts, cost me $95 – almost as much as the entire urgent care bill. Let’s say the urgent care facility would have charged $25 less for the stitch removal. How far would you drive out of your way to save $25?
A final look at the figures concerning my episode:
· Urgent care office visit and procedure: $135
· ER visit and procedure (estimated): $350
· Primary care physician office visit: $95
See also: Unwinding ACA: Impacts & Implications
Take a look at your health plan ER, urgent care and primary care physician usage rates compared to the benchmark. If your plan is of size, your health insurer or administrator will furnish these data. Are the results normative?
If you offer a traditional health plan (i.e., a plan that isn’t a high-deductible health plan), review your copayment levels for urgent care, ER and primary care office visits as compared to the benchmark. Next, consider the spread between these copayments. Are the levels creating the desired financial incentives?
If you offer a high-deductible health plan, do your employees recognize the savings and value available via urgent care facilities?
Is your tupelo tree in need of trimming? Consider hiring a professional.