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Over the past several years, we’ve seen a dramatic increase in the cost of healthcare. With insurance deductibles and co-pays on the rise and co-insurance shrinking every year, our personal healthcare expenses have never been higher. Patients often feel powerless when it comes to their medical costs, but that doesn’t have to be the case. In this Q&A, Dr. Cook explains how we can be smarter consumers of our healthcare to successfully manage expenses while getting the best possible care.

What factors affect the cost of care?

The main factor impacting your cost of care is the type of facility you visit. There are two main types of fees – physician fees and facility fees – and what you’re charged will vary depending on whether you go to a hospital or private practice. Hospitals and hospital-owned practices and clinics charge patients both a physician fee (for physician services) and a facility fee (for the facility overhead). This practice is known as “provider-based billing.” Private physician practices, on the other hand, aren’t allowed to charge a separate facility fee, which is why going to a private practice is always a more cost-effective option. Another factor that increases your cost of care is the number of tests that are run. The more tests you undergo, the more you pay, which is why going to the most qualified physician who knows what tests are actually needed is important.

When I’m paying a higher cost, am I receiving better treatment?

No, very rarely is this the case. Consider this – when you go to the emergency room, you’re rarely seeing a physician who specializes in your specific condition. Because they don’t have as much knowledge in this particular area, they may call for more extensive (and expensive) testing. Even worse, they may not have the skill or experience needed to treat the injury. So, while you’re paying more at a hospital, you aren’t necessarily getting better treatment. Patients can actually save money and improve outcomes by going to a specialist at a private practice with advanced training and knowledge specific to their injury or condition.

If I have an injury or illness, how do I decide when to go to my primary care physician versus the hospital versus a specialist?

In the event of a life-threatening injury, always seek immediate medical treatment at your local emergency room. Sometimes a situation will arise where you need to go to the hospital, but 70-80% of injuries or conditions can be treated on an outpatient basis. A good place to start is with a call or visit to your primary care physician. Your family doctor will be able to tell you whether it’s something they can treat and can direct you to a specialist or hospital when appropriate. If you have a more advanced injury that may require a specialist, such as a broken arm, you can also call a specialty practice directly for care. In our current health system, patients very rarely need a referral to see a specialist. Oftentimes, the specialist will be able to triage you on the phone and let you know whether it would be appropriate for you to seek treatment at their office versus the hospital. Getting treatment from a specialist works in your advantage because more often than not, you also have access to a team of physicians trained in different areas within that specialty, allowing you to receive all-encompassing treatment.

What can I do to stay within my healthcare budget without sacrificing quality of care?

Probably the number one thing you can do to save money and ensure the best course of treatment is to slow down and analyze the situation. It’s natural for us to make decisions based on emotion when it comes to our health or the health of a loved one, especially when the unexpected occurs. However, we are better served to take a step back, evaluate the medical condition rationally and determine the most appropriate course of action.

  • If you need to be treated at a hospital, call your primary care physician or a specialist – the Hand and Microsurgery Associates physicians can meet you at the hospital and/or direct the care administered at the hospital to ensure you’re receiving the best, most appropriate treatment based on your condition.
  • Select the right physician. Find a physician that not only has expertise in your condition, but one you can trust to administer cost-appropriate care. Don’t be afraid to call around to different practices and ask questions. You can also ask friends, family or your primary care physician for referrals.
  • Ensure you’re aware of all the costs that go into your bill up front – from the visit, to x-rays, imaging, procedures, surgery, etc. Understanding the type of facility and how their fee structure works is important, as is knowing what tests are being run and why.
  • Keep an eye out for excessive testing – this is an easy way for doctors to rack up patient bills. Always ask questions about what tests are being run and the purpose behind them.

It is possible to gain control when it comes to the quality and cost of your healthcare. By  understanding what goes into your bill, what factors can increase your costs and what treatment options are available, you can make more informed decisions to ensure you’re getting the best possible care at the best cost.

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