Monday, November 16, 2015

You Must be a Good Healthcare Customer Before You Can Be an Effective Patient

(Photo via
There’s been a lot of articles and discussion about whether we are a healthcare patient or a healthcare customer; and whether we all need to become more intelligent healthcare customers in order to be effective patients capable of achieving meaningful outcomes. In the tweet chats I’ve attended where the differences between being a patient vs. customer are discussed and in the the articles I’ve read, some people seem to have a very clear idea of the difference between the two; others not so much. The patient-customer often has a different perspective on this topic than the physician-provider. My sense is that most physicians view those they serve as patients while more and more individuals consider themselves as customers of those physicians.

Patient? Healthplan Member? Consumer? 

There’s an argument that “Customers go to places willingly, while patients go to hospitals mostly out of necessity.” Indeed, who’s going to be looking for an in-network hospital and checking on physician credentials while lying I’m in the back of an ambulance? Physicians argue that they offer a special breed of services and that providing “customer satisfaction” and needing to “encourage brand loyalty” are not and should not be part of their responsibility.

While I’m not sure where the majority or “popular opinion” stands on this topic, I can attest for my own situation: Over the past few years, I have been performing many duties and tasks associated with being a healthcare consumer.

What are these consumer duties I’m performing?

Searching for an In-network Provider

Almost every year I have to validate that our various family physicians are still contracted with our health plan. In fact, the PCP for one of my son’s changed practices this year and didn’t tell us. I found out when I started receiving invoices with out of network charges! Sure, I’ll pay $350 for an office visit. Not!

Validating Professional Services for Primary Services Performed at a Facility

Closely related to ensuring coverage by in-network providers, I spent some time this year making sure that radiologists reading various imaging exams performed by a facility that billed their charges separately from the radiologist were also contracted with my health plan. Many PCP’s will ensure they send an imaging order to an in-network facility but the in-network facility – for whatever reason – may send the image to be read by an out of network radiologist. That's not good.

Researching Physician and Facility Background and Ratings

Closely related to ensuring that providers are in-network, it’s important to me and my family that we feel as comfortable as we can with the actual physicians and/or hospitals we're going to receive services from. The evolution of existing rating and review sites and the advent of various new rating systems offer us an opportunity for peace of mind – however subjective some of these ratings and our interpretation of them may be. 5 stars? What's that really mean?

Setting Appointments

This can be a breeze or a real hassle. I’ve seen a few practices with some really nice web-enabled appointment setting solutions that let me pick my own appointment time. And other practices where I’m told when I must come without much, if any, ability to choose my own time. What a hassle!

Ensuring Services are Authorized

On several occasions over the past couple years, I’ve had issues with ensuring services that require some level of pre-authorization were, in fact, properly approved prior to the procedure being performed. Knowing how to properly request and confirm that a preventive procedure like a colonoscopy is 'coded' as a screening exam is apparently something every healthcare consumer over 50 must now know how to do. I always wanted to be a medical coder; and now I are one. :)

Managing HSA Funds

I love my Health Savings Account. And I hate reconciling and balancing it for tax purposes. There has to be a better way. I can write a book on the hassles of this and I’m sure somebody already has so I’m not going to say anything more on this topic other than it's something a customer often has to do – not a patient.

Now and Going Forward

And there are other healthcare-related tasks and duties I perform on a regular basis - mostly related to administration and complianc. So I’m clear that there is definitely a difference between being a healthcare customer and being a healthcare patient. I don’t care for doing the customer duties I’ve listed above. But in some way, shape or form I have to do all of these items for the various products and services I purchase for home, auto, investment and personal life. I’m just hopeful there are companies out there addressing these healthcare customer pain points.

For more information on healthcare and healthcare information technology topics, consider following me on Twitter where I share as ShimCode.