A Tale of Two Labs
Today, I had a visit with my Primary Care Physician (PCP), which unsurprisingly led to some lab tests. But my experience with lab tests today was quite different than it has been previously, and I think it has some lessons for healthcare and where we’re going in our industry. First, let me say that I love my PCP. We have a great working relationship, and I feel like we’re partners in care ensuring that I can manage my thyroid condition. (For those of you with thyroid issues you know how horrible you feel when you’re not managing your condition well). However, my PCP works for a fairly large medical practice who in the last few months has launched their own lab services, conveniently located in the same building. Right down the hall from their lab is one of the national lab companies. I pretty much always go to this particular lab company because they’re in my PCP’s building and there’s an office right down the road from my house. It also used to be the default location my lab orders were sent to.
My PCP has been doing electronic lab ordering for a while, and she’s generally forward thinking when it comes to using technology. I distinctly remember our conversation about Direct messaging and how she’s one of two doctors in the practice who uses it regularly. So today, like every other time she orders labs for me, she sent the order electronically and told me to go downstairs. As usual, I headed to the national lab service and signed in (using their new electronic sign-in process, which was really quick and easy). But this time, the receptionist called me to the front and informed me they didn’t have a lab order. I was very confused until the front desk staff told me that my doctor had probably sent the labs to their own lab right down the hallway. Unbeknownst to me, the default setting for electronic lab orders is now to my physician’s lab and not the national lab. None of that was specified to me at my doctor’s office though.
Since I work in healthcare, I was aware that there was probably a cost difference between the national lab service and my physician office’s lab. So, when I got to my physician’s lab my first questions were, are you in network for me and what will be my out of pocket cost? I have to hand it to the front desk staff at their lab, she looked me dead in the eye and said you should go back to the national lab service, and then offered to print out the lab order for me. Unfortunately, most patients don’t know enough about healthcare to even ask these questions. When I mentioned that to the very nice, honest front desk staffer, she agreed and said that she often feels bad for patients because they will pay more out of pocket and have no idea they could pay less by going right down the hall. Worse yet, she couldn’t even tell me an estimated amount that I would be responsible for if I got my labs done there.
Now compare that to my national lab experience. After I returned with my printed out order, I was given, in real-time, an estimate for my out of pocket costs. I know it was real-time because I updated my insurance information in their system right before I was given the estimate. I’m including a picture of the estimate because I think it demonstrates how patient friendly the information was.
They showed me the allowed rate and how much I would likely have to pay out of pocket because my deductible isn’t met yet. They also asked me to sign a document, provide my credit card, and agree to an automatic charge for the estimated amount. The lab has made a reasonable tradeoff here. They get guaranteed, timely payment while I get to know the price in advance. Seems like a fair trade. So the question is, why can’t every experience with the healthcare system be this way? Because I know how insurance works, I was able to be an informed consumer, saving my health plan and myself money. I don’t blame my PCP for sending me to their lab; I’m guessing she has no idea that it would have cost me more to go to their lab. Plus their default setting for lab orders is now their lab, so she probably didn’t think too much about it. If she had information in her CPOE module that indicated my out of pocket cost would be lower at another lab, would she have changed her ordering decision? Maybe, maybe not if she’s being pressured by her leadership to keep everything in house. Which is why providing the price information to patients is important.
What was clear to me today is that price transparency is possible and in real-time. I know that not everyone is going to compare prices for everything. Full disclosure, I would pay more out of pocket to keep seeing my PCP because I like the care I receive and the partnership we’ve formed; cost wouldn’t be a factor for me. But maybe if we started with making pricing data for testing services available to providers at the point of ordering and to patients before they do the testing, we could start to see more consumerism in healthcare. It’s clearly possible, so let’s not give up on making prices transparent to patients, even if we have to start small.