MedCity Influencers, Hospitals, Physicians

Surprise Bills for Subpar Care: The Lack of Transparency in Today’s Medical System is Robbing Us From Fundamental Rights

Healthcare providers should deliver care to patients in all-inclusive models that focus on treatments rather than squeezing profits. In my opinion, charging a $50 convenience fee for a flu shot I could have received for free at CVS or Walgreens is unacceptable

On a warm, early October day, I decided to do the responsible thing and get my annual flu shot. It’s a routine that I’ve done every year since I can remember. So I visited my primary care provider, got a jab, and went about my day with a sore left arm. To my surprise, a few days later, I received a bill for $50. Surely, my flu shot is free and covered by insurance? But instead, I was billed for the provider’s time and a few other unintelligible things. $50 for a free flu shot? Seemed suspicious.

And then a few weeks ago, The New York Times published an article titled “Emailing Your Doctor May Carry a Fee.” In it, the Times exposed the fact that several large health systems, including the Cleveland Clinic, are beginning to charge a nominal fee to email or message with their provider. At that moment, it clicked. The healthcare system today is designed to squeeze profits above all else.

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As the CEO of a pediatric telehealth company, I’m no stranger to the concept of the healthcare system wanting to make a profit, but these two incidents set my mind racing. How can we so blatantly put profits over providing adequate care? And since when did healthcare become a menu of expensively-priced, opaque options?

Antiquated billing systems are disincentivizing patients from receiving the care they need

Due to a lack of transparency in pricing and billing in today’s healthcare system, patients have no idea when a charge will land in their lap. And by charging for a routine experience like emailing with a provider, patients will be deeply deterred from reaching out when they need help urgently.

The numbers are staggering. According to a report released this year by The Commonwealth Fund, the U.S. has the worst health outcomes among high-income countries. The report found that people in the U.S see doctors far less often than those in most other countries, proving that the current billing system is keeping patients from seeking proper care.

Providers prioritizing profit over care sheds light on a broken medical system

This move by Cleveland Clinic to charge a fee to patients who emails their doctor sheds light on a larger medical system issue in which health systems are incentivized to drive profit rather than deliver quality care. Rather than rolling up pricing into one flat fee for services, they provide an excuse for patients to wait until things are urgent before seeking treatment.

Providers want to administer more care, and better, but are beholden to the billing constraints that come as a byproduct. It’s no surprise that the average medical visit in the US is only 10-17 minutes long. More than 40 percent of Americans report delaying or avoiding medical care because they are concerned about the cost. As a result, they rely more heavily on the emergency medical system. This means that the total cost of care for most patients rises, which causes undue financial burden on individuals, and the system at large.

An inclusive care delivery experience can save patients and healthcare systems

I’m by no means advocating that care should be free, and I believe that the system can and should profit. As a healthcare founder, I know first hand the need to make profit in order to keep the lights on and pay physicians what they deserve. However, I firmly believe that healthcare providers should deliver care to patients in all-inclusive models that focus on treatments rather than squeezing profits. In my opinion, charging a $50 convenience fee for a flu shot I could have received for free at CVS or Walgreens is unacceptable – especially in the midst of a Tripledemic.

It’s time to create a care delivery experience that is accessible, inclusive of flat fees, and offers seamless patient-doctor interactions. In the backdrop of an unstable economy and rising inflation, patients want the comfort of knowing that they can get medical care without being squeezed for every penny. This will not only reduce provider burnout for 52 percent of physicians, and increase the availability of medical care, but it will also make patients more satisfied and contribute to more positive health outcomes, which is what we’re all striving for in a value-based care world.

Photo: nito100, Getty Images

Ellen DaSilva is the Founder and CEO of Summer Health, which offers message-based pediatric medical services within 15 minutes. Summer Health has raised a total of $7.5M from Sequoia Capital, Lux Capital, Box Group, Metrodora Ventures and others. Before starting Summer Health, she was the Head of Business Development at hims&hers, focusing on strategic partnerships and growing the business. She is also an active angel investor as a Sequoia Scout in Seed and Series A consumer tech companies.
Ellen obtained her MBA with Distinction from Harvard Business School. During her time at HBS, she was a Partner at Rough Draft Ventures, the pre-seed fund of General Catalyst. Prior to business school, she managed a unit of the Business Operations team at Twitter. She co-authored the book Pitching & Closing: Everything You Need To Know About Business Development, Partnerships, and Making Deals that Matter, a guidebook to business development and revenue-generating partnerships at tech startups.

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