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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Customer Disservice: Health Care #FAILs again and again

Disservice (dĭs-sûr’vĭs)

  1. A harmful action; an injury
  2. An act that is not just

Our health care system is completely devoid of customer service. It is pathetic.

I took my son to have a simple tympanostomy (ear tubes) procedure this morning. I show up, sign in and take my seat amidsts the throngs of people in the surgical center waiting room. I brought my laptop and some reading materials to bunker down for the long wait ahead.

20 minutes later I get called up front to sign some additional paperwork. Instead of being greeted, 15 documents each complete with a full page of legalese is shoved my way regarding various aspects of responsibility, payment, agreement, arbitration, and host of other information. The grumpy lady has clearly done this a thousand times and she has absolutely no tolerance for any of my questions. She paries my first few skillfully, but I don’t let her blunt my questions regarding the finances.

She shows me that the facility is charging me $5,600 but that fee has been reduced by the insurance to $1,799. This is an all in fee for the facility only (includes staff, equipment, monitoring, etc) and does not include fees charged by the physician and the anesthesiologist. I ask what those charges will be (I already knew ahead of time), but she says she is not responsible for their charges and that I would have to speak with those providers about that. I start asking her why they don’t bundle everything into one price so I can compare across various combinations of facilities and providers. She has no idea what I am talking about and ends the conversation by giving me their phone numbers. Take your seat Mister, how dare you ask a question about pricing comes across clearly as she stares me down to my seat.

I immediately pick up the phone and talk to the physician office. After about 10 minutes, I finally get the billing person who is able to provide me the CPT code (69436) and Zip Code (92691) as well as what they charge for procedure ($345). I tell here I am not interested in her price because it is irrelevant and that Blue Cross has already dictated the price that you are going to get. A little defensive, she then relays to me the the administratively set Blue Cross reimbursement that has been dictated to this particular physician ($208.08).  I then ask her about bundling of services and created an Ear Tube product that would include all the components so that I can compare across facilities and providers. She has no idea what I am talking about. I give her the hamburger example (I don’t get separate receipts for tomoatoes, buns, and burger – I get a single price for the thing I want – the complete hamburger). I refer her to as an example and she thinks this sounds like a good idea.  When I ask why they don’t do it now that she understands, she says that she doesn’t think the physicians would ever agree to work in that way. She tells me she will pass this along to the physicians, and with a laugh that indicates that will never happen, we end the call.

Next, I call the anesthesiologist group. First the lady attempts to tell me she can’t give the pricing because it is a HIPAA violation. I quickly disabuse her of her ignorance and get her manager on the phone. Anesthesia is unique in all of medicine because anesthesiologist charge for their time in increments called units (typically 15 minutes). So they get a “set up” fee and a “time-based” fee for their services, both in terms of units. So I ask them what their per unit charge is and the manager tells me that it is proprietary information. I call him out on it and say that pricing information is not proprietary, perhaps his costs structure is, but he has a duty to tell me the cost of the service I am about to engage him in. I am pretty frothy at this point and really lay into this guy. He still refuses to tell me his proprietary, negotiated per unit rate with Blue Cross but relents on giving me the overall price. He then passes me along to someone else who looks up in their database and tells me the cost will be either $300 or $360 for the procedure for either a 15 minute or 30 minute anesthesia time. So, knowing they go in 15 minute unit increments, I can tell that there is either 5 or 6 units involved, and therefore a $60 / unit price. So, full pricing is 4 units “setup” and either 1 or 2 units for their time. So much for your proprietary formula and negotiated pricing. $60 bucks every 15 minutes or $240/hour for anesthesiologist time. Thats mid-tier lawyer rates for South Orange County but interesting in how at least this type of physician’s time might be valued by insurance companies.

So finally, after about 45 minutes of phone time, by someone who knows the ins and outs, all the secret handshakes and covert codes, and most aspects of healthcare financing, I am able to arrive at an all in price for a very simple surgical procedures:

CPT Code: 69436
Zip Code: 92691
Facility Fee: $1,699.00
Surgeon Fee:  $208.08
Anesethsiologist Fee: $360.00
TOTAL:  $2,267.08

This is great to know the price information for my selected combination of facility and physicians. However, I have no information on outcomes achieved, safety rates, customer satisfaction, or other metrics to determine if I would not be better off with a different combination of facilities and physicians. What do you think the response was when I attempted to ask about health outcomes for my physician?

Pin drop, anyone?

This is not just another rant, but meant to highlight that the very basic, fundamental courtesies expected during a consumer transaction are all but non-existent in health care. Simple things like getting pricing information, like getting helpful customer service, like understanding what you are buying, and the quality features that attract you to purchase something in the first place. Health care should be one area where customer service is impeccable. I believe you begin to see “brands” emerge that get this, invest in it, and deliver it consistently over time. Looking forward to the ongoing retailization of health care – it truly needs it.

14 comments on “Customer Disservice: Health Care #FAILs again and again

  1. Scott

    Most people are “happy” with their health care, according to Kaiser’s research. Its truly amazing. Could it be our expectations around quality have been so diminished that we are just happy to get any treatment at all ?

    While all the rage surrounds health insurance reform, its really a reform of delivery that holds more significant challenges and opportunities. Any thoughtful buyer of US medical services has experienced situations similar to the ones you describe. Its why “consumer driven” and “free market” policies on the buyer’s side will not work alone. Your son’s procedure and the reactions you received upon questioning it are truly laughable but mostly sad. A system that pays for procedures, drugs and services – instead of valuing outcomes leads to our problem – there are few quality measures that serve as a factor for reimbursements. Since Medicare and private insurance have generally not focused on quality metrics when paying providers, you create a culture of delivery that does not value it.

    Unfortunately there is less focus on changing delivery models to value outcomes than the topic of how to pay for it all. It is why Mayo’s CEO Cortese recently said, “it doesn’t pay to be good”, when referring to the health care delivery system – and your son’s ear tube procedure only exemplifies this point. By the way, I hope he is doing well.

    You are correct in asserting that those competitors who increasingly integrate service delivery with the metrics of value may be highly successful in a marketplace that has come to not expect it.

    1. Bryan,

      Great comments. By the way, groups like Kaiser, Mayo, and Geisinger have already mastered the basics of healthcare (IT infrastructure, incentives, coordination, measurement, and transparency) so now they are able to focus on the customer service elements. I have been with Dennis Cortese in a meeting with all the other leading health care systems in the country when he discussed this very point. It doesn’t pay nor reward to do good – they just do it because it is the right thing to do.

      Customers need to expect more. Unfortunately, they are not really “free” to vote with their wallets as it is already predestined where they can go. One of the biggest things that I hope disappears from the horizon is the the proprietary physician network. It is ridiculous, does not increase value, prevents information / patient flow to best providers, and serves to increase administrative overhead significantly.

      We shall see how the coming years proceed but I am a firm believer in customer service being a new criteria from which physicians, procedures, and facilities will be selected.

  2. Scott,
    As you well know, this can’t be forced across the legions of docs after the fact…it will be driven by consumer uptake (and demand for) better service from those leading the charge.

    Compare your experience to the shopping experience we’ve put together at . The charge is not to make all docs function better. The charge is to reward those that volunteer their information and pricing and quality data and service approach…these will be the seeds of the consumer-centered health system to come.

  3. This is an excellent example of the inadequate pricing methods for healthcare and why many Americans go “bankrupt” from their healthcare expenses. Imagine those who don’t have insurance.. they find themselves in a health related crisis and have no other alternative than to trek to the ER, via their own transportation, or worse yet, by ambulance.

    The “run around” you received when asking for specifics regarding your bill are typical for most health services. You found, however, more information than I was ever able to obtain regarding a hospital stay I had for 2 days which cost in excess of $25,000 – unbelievable.

    I have been told, and I have read prominent books on the topic of healthcare and your statement,

    “…the very basic, fundamental courtesies expected during a consumer transaction are all but non-existent in health care. Simple things like getting pricing information, like getting helpful customer service, like understanding what you are buying… ”

    Perhaps this idea is what has spurred online and print articles on the topic of measurement for quality health outcomes and associated pay-for-performance objectives for facilities and providers.

    Thanks for sharing.

  4. Wayne A says:

    I learned a lot from this blog post. The health care system does need some reform but I’m not sure the current plan under the Obama administation is the right answer. I currently have private health insurance and I hope the new plan is not planning on affecting that.

  5. Health care systems don’t give service, pathetic or otherwise. People give service to other people. I truly understand, and agree with, your anger and frustration and disbelief at being treated as you and your child were. I probably should even say, “your child…and you”: you don’t mess with my kid, even when he doesn’t know about it! Systems don’t know how to apply criteria for employment, or how to teach simple manners let alone more complicated approaches to information and…well…people. Systems don’t typically build in autoregulatory mechanisms for their own elements. We just assume everything will work. Just like educating – or, God forbid, training! – doctors: we assume that enough anatomy and physiology assimilated into a cortex will result in a system “node” where “care” will take place. (And then we wonder, munching our way through the refrigerator in the Doctors’ Lounge, why some dingleberry can’t even make and commit to a bloody diagnosis, let alone a reasonable therapy, let alone to the REAL care patients and other stakeholders crave. And we resolve not to take our children to him.)

    Systems don’t give service. People do, trite as it sounds. And doctors are people who went to doctor school; they are not doctors who went to people school and failed important classes. Ditto secretaries. Ditto insurance executives (bless their evil hearts, as we say here in Georgia). Ditto the creators of the CPT and ICD and even the MS-DRG systems.

    I’m not trying to be more rude than usual.

    Only… it’s a problem in translational science, I guess, and we all pray that science works. We assume that the sciences of organizational structure (management science and group psychology and whatever else) and economics and pharmacology and anatomy ad infinitum create results that are immediately translatable into similarly falsifiable claims (thus, “scientific”) at the most intimate interpersonal level. And we assume that our observations at that level, along with our hopes and prayers and frustrations, translate into falsifiable claims at ‘higher’ levels of the hierarchy.

    Maybe it just ain’t so.

    The mathematics of kissing begins by assuming that men and women are ellipses. That doesn’t even work for mathematicians… and not for high school students either.

    So your tale is about people – individual people – and that is what we all must deal with. It remains to be seen if we can.

  6. Heather M. says:

    Thanks for sharing your story.

    There needs to be some sort of “truth in medical services”. Maybe it’s just me, but I never even have a clue what medical services will cost until I get the insurance-adjusted bill.

    Most people are probably like me. If we all began to be much more cost conscious and compared “estimates”, we could “shop around” a bit. Of course, when your child just fell down the steps and requires medical treatment, who has the time to check prices?


  7. george says:

    The day the doctors got into bed with the pharmceutial companies is the day the personal side of them went away. Very hard these days to find one that is worthy of your time and even then they find a bookkeeper that makes it tough to smile. Very informative article I agree and I would suggest that this is also worthy of reading along with our blog on the momentum of health alternatives

  8. Nate says:

    Scott, I like the post. Good thing this specific issue will be solved by the Obama Health reform package. 😉

  9. Darryl says:

    This is just a symptom of the larger problem that congress (and now seemingly, the Supreme Court) are under the thumb of corporations. We all know that the insurance agencies make the rules for health care. If this were not so then our health care system would be not be the giant mess it is today.

  10. Steve Parker says:

    Thanks for sharing your story with us, I agree with all that health system is need reform. I search & found some radiology medical transcription services provider it has all the services.

  11. Rockon says:

    Thanks for sharing.

    I agree with all that health system is need reform.

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