Now that we are in the dog days of summer, I have some time to catch up on some of my backlog. There were two items today that caught my attention.
John Goodman (the policy analyst, not the actor), has been writing in his blog about the relationship between the underlying cost of care, wait times, amenities and quality. In an April 27 blog post he observes that when costs are transparent, and consumers have skin in the game, providers will compete on price and quality to garner business. In a follow up post dated June 29th , he writes about the inverse, what happens when third-party payors obscure the true cost of care. Goodman notes that when patients do not make choices based on price, they will make choices based on time, quality or amenities. And since quality information is the hardest to gather, patients will make use the markers that are easier to see, time to access, and amenities. Goodman observes in markets where there is a undersupply of services, hospitals wanting to cater to patient satisfaction might not be as quick to improve quality if it means grumbling patients have to wait longer for services. And in markets that have oversupply, many facilities go the less expensive route and compete on amenities, rather than instituting the more expensive changes that bring up quality levels. Goodman says it best “Some of the literature on hospital economics suggests that quality improvement is quite expensive, and that dollar-for-dollar amenity improvements will increase hospital revenues by more than quality improvement. This is coupled with surveys that find patients more sensitive to amenity changes than to quality changes. (Of course, this latter finding may only reflect the fact that hospitals aren’t really trying to communicate quality information.)”
A perfect intersection of what Goodman is talking about is a new service called InQuickER. It is a website that allows patients to schedule their ER visits with participating hospitals. My first reaction was “Are you kidding?”, but after I counted to 10, I started to smile.
The concept is brilliant. Emergent cases are notified to go to the nearest ER. Non-emergent cases are slotted in predictable times. Patients love that they are not sitting around the ED waiting room. Staff likes it because it allows load balancing of non-critical cases. Participating hospitals like it as they are able to offer a low-cost perk, and differentiator. There is a fee to use it, which looks like $4.99 for an urgent care center appointment, $9.99 for an ED appointment.
However I have to ask, if the patient is paying the true cost instead of the co-pay, would they be going to the ED for non-critical care in the first place? Or would they go to a physician’s office (or retail clinic) instead?
Patching the Boat 
Janet, you are sooooo right to ask “if the patient is paying the true cost instead of the co-pay, would they be going to the ED for non-critical care in the first place?”.
As you’ve suggested, they probably would not – they would head for a doctor’s office or retail clinic instead.
With retail clinics, the trick is finding one. The leading hosts are pharmacy chains; 10% or less of pharmacies in those chains house a clinic. The clinic hosts don’t seem to know it, but they have a “brand within a brand” challenge similar to that successfully solved by Intel with their Pentium and other “branded” chips.
Happily one element of that challenge – we express it as “where is the “cereal aisle” for retail clinics?” – is effectively addressed by leading web-based, smartphone-friendly clinics locator utilities like Healthcare 311 (http://www.healthcare311.com).