Untangling the Mess

A few weeks ago I received a call from a close friend asking for some help. As he is currently undergoing treatment for cancer (thankfully with an excellent prognosis), I assumed he wanted my advice on a medical decision.

I was relieved to hear his treatment was going well, but was taken aback at his request. He wanted me to help him untangle his mountain of medical bills. He was staring at a pile of paper itemizing his every test, diagnostic procedure and treatment and could not figure out what he was being charged, what his insurance had paid and what he would ultimately owe. It took me hours to review his bills and to this day, I am not sure that I fully understand all of the charges.  I can only imagine the fear and frustration that all of our patients feel when they receive medical bills they can’t understand. The plea for help from my friend served as a wakeup call for me. If a CEO of a medical center can’t untangle one person’s tab, how can we expect our patients to figure it out?

There’s interesting action on this front. The federal government is now looking for ways to standardize medical bills to make them easier to understand. The U.S. Department of Health and Human Services launched a contest for companies in the medical industry to design a bill that can eventually be used across health care making it easier for patients to understand. Winners will be announced next month and I am anxious to see the solutions offered.

If we expect patients to become responsible and cost conscious “consumers” of health care, the industry needs to deliver a medical bill that people can actually understand and a billing process that makes sense.

Apple of Health Care

Those who know me, know I am a fan of Apple—the company and their line of products. Like most people, I find their devices highly intuitive, user friendly, fun and engaging. I love that they offer a complete portfolio of technology that meets all my needs. But most importantly, I admire how their products are completely integrated—my phone syncs with my watch/personal fitness monitor which talks to my iPad which then backs up to my personal computer—allowing all of my information to be accessed from one device. When you purchase an Apple product you step into a complete and closed system of technology and entertainment and rarely need or want to leave. In the business world, this is known as vertical integration. Whatever you call it—it’s a savvy strategy for developing loyal, lifelong customers.

At Jupiter Medical Center, we are striving to be the Apple of health care right here in Palm Beach County. By that I mean, our goal is to provide our patients with services at every point along their health care journey and do our best to make sure the care is seamlessly integrated along the way—decreasing time and costs while improving outcomes and value. We want our patients to be able to step into the Jupiter Medical Center system and get all the things they could possibly need from a flu shot, to maternity and pediatric care, to imaging and diagnostics or world-class oncology treatment, should they need it. Beyond building a robust set of services for patients, each time they come in contact with Jupiter Medical Center at any entry point, their health information is captured, electronic medical records sync, and this essential data can be accessed by members of the care team everywhere up and down the line.

In technology, Apple has championed vertical integration. Applying this model to health care will not only help remedy the sometimes fragmented and dysfunctional way care is currently delivered, it will ensure a more satisfying "user experience."

The High Price of Dying

My father passed away last year. A vibrant and healthy man through out his life, he was now suffering from cancer and experiencing the early signs of dementia. As I prepared to go home to Boston to be with him, I consulted a former colleague and renowned physician, who laid out for me what I could expect for my father moving forward: He would become weak and sick from chemo, would soon have a compromised immune system and become unable to fight an infection or common cold. As a result, he would most likely and ultimately end up in the ICU of a hospital battling pneumonia (a fight he would soon lose). And at the end of all of this, he would be reliant on machines to keep him alive for some indeterminate amount of time.

I knew this was not what I wanted for my father and more importantly, I knew this was not what he would want either. And so my family and I chose to move him to a wonderful hospice facility, where he peacefully spent his last few days free of machines, comfortable and surrounded by family in a beautiful and calm setting. While it was an incredibly difficult time, I was comforted in the choice we were able to make regarding my father’s end-of-life care.

As health care professionals, we are focused on patient outcomes and restoring their health. As an industry, what we sometimes fail to realize is that the best outcome can sometimes be dying. Each year, it is estimated that 30% of Medicare expenditures (over 50 billion dollars) are attributed to the 5% of patients that will die that year with one-third of those costs occurring in the last month of life.  Furthermore, most studies show that if the person is sick enough, this type of medical intervention does not have a positive impact. In fact, it can make those last days and months of life worse.

I believe that we need to not only provide opportunities to openly discuss end of life options with patients before it is too late, but also devote resources to offering patients and their families the kind of services and space they need in those final difficult days. It was what I was able to provide my father and what I think all families deserve. Don’t you agree?