From the
PRESIDENT
JOHN L. ROBERTS, MD
GLMS President | [email protected]
ALEXA
I
recently purchased an Amazon Echo so that
Alexa could tell me the answers to life’s most
perplexing questions.
“Alexa, what time is it?”
“The time is 9:22 am.”
“Alexa, how much does an MRI cost?”
“Cost who?”
“Alexa, how much does an MRI cost me,
the doctor?”
“Nothing.”
“Alexa, how much does an MRI cost my
patient?”
“It depends.”
“Alexa, on what does the cost of an MRI for
my patient depend?”
“Does your patient have insurance?”
“Alexa, what is the cost of an MRI for my
patient who has no insurance?”
“Nothing, because he probably won’t get it.”
“Alexa, what is the cost of an MRI for my
patient if he has insurance?”
“It depends.”
“Alexa, on what does the cost of an MRI for
my patient with insurance depend?”
“The cost of an MRI for your patient with
insurance depends on your patient’s age, gender,
insurance company, the type of insurance policy
with that company, his deductible and whether
he has met his deductible, whether the study
will be as an outpatient or inpatient, the site
where the MRI is done, the month of the year,
the day of the week, the hour of the day, the
current weather, the color blue, ….”
“Alexa, stop!”
“Alexa, it is 9:45 am on Friday, March 23,
2017. It is 58 degrees and cloudy. My patient
is a two-month-old premature male infant.
His parents have the best insurance policy
from the best insurance company. His parents
have paid none of the $5,000 deductible. The
MRI will be scheduled as an outpatient and
the color is blue. Where can my patient get
the cheapest MRI?”
“I do not have enough information to answer
that question because you interrupted me. But,
your patient might try Dubai. Expedia.com has
some cheap travel packages this time of year and
children stay for free.”
Last month I was discharging a premature
infant from the hospital and I ordered an MRI
to be done one month post-discharge to assess
for periventricular leukomalacia, a predictor
of cerebral palsy. I realized I had no idea how
much the study would cost this young family,
nor did I have an easy, efficient and dependable
way to find out. If I really wanted to know, I
could have called around to each of the 21
medical providers in Louisville who provide
MRIs. Or, I could have called my patient’s
insurance company to find out how much
it would pay for an MRI at in-network and
out-of-network sites. Or, I could have gone to
the Kentucky Cabinet for Health and Family
Resources which, by the 2015 revised Ken-
tucky Statute 216.2929, is required to “prepare
and publish, in understandable language with
sufficient explanation to allow consumers to
draw meaningful comparisons, a report on
health care charges, quality and outcomes that
includes diagnosis-specific or procedure-spe-
cific comparisons for each hospital and am-
bulatory facility.” But I didn’t do any of these
things because none seemed easy, efficient or
dependable.
Later in the day I was booking my travel to
Washington, DC. I shopped around on one
single website. Eventually, I booked my air-
line ticket with a specific airline, for a specific
seat on a specific day, at a specific time, for
a specific cost. I provided my frequent flyer
number to earn points for the time in the fu-
ture I would use the same airline. I provided
my credit card number and paid for the flight.
From the website I was linked to a car rental
company of my choosing, and I booked the
car of my choice based on how much I was
willing to spend. I declined the extra insur-
ance coverage because my personal auto in-
surance covered some of the contingencies and
I have the personal resources to cover others
if something bad happened. I provided my
AMA membership information and received
a discounted rate. I provided my credit card
number and paid for the car rental. Then, from
the same website, I was directed to the hotel
of my choosing. I provided my hotel loyalty
rewards number and the site suggested the
type of room I usually book. I chose it and the
number of days I wished to stay and whether
I wanted the continental breakfast and daily
newspaper. When I finished all this booking
I knew what I was getting, when I would get
it and what it would cost. The whole process
took 20 minutes. I had confidence that in a
month my trip would go well. Following my
trip, I will have the opportunity to “grade”
each of these services so that others can learn
from my experiences. This is how things are
supposed to work!
Why can’t our health care system work like
this?
I hope you are in communication with your
congressmen about our health care system.
While we are repealing, replacing or repairing
our health care law, wouldn’t it be an oppor-
tune time to redesign our health care system?
“Alexa, what time is it now?”
Dr. Roberts is a neonatologist with the Uni-
versity of Louisville Physicians and the Vice
Dean for Graduate Medical Education and
Continuing Medical Education at the University
of Louisville School of Medicine.
MARCH 2017
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