How can you get the same procedure from the same surgeon, for two drastically different prices? It’s because there is no correlation between price and quality– the quality doesn’t rise directly with price. The price could skyrocket while the quality doesn’t change or may even decrease.
For example, you schedule your surgery from Doctor A, let’s call it a knee surgery and the doctor’s office tells you, “’ Dr. A’ has an opening for knee surgery on Monday @8am or Tuesday @8am.” You choose Monday because you want to get your surgery over with and recover sooner. Little did you know, “Dr. A” performs surgeries out of the hospital on Mondays, Wednesdays, and Fridays, and performs at the Ambulatory Surgery Center (ASC) right across the street from the hospital on Tuesdays and Thursdays. “Dr. A” performs the same quality of surgery at the hospital and the ASC. However, the cost of surgery at the hospital could be $16,000 while the same surgery from the same surgeon at the ASC could cost $4,000. You just made a $12,000 decision by scheduling the surgery on Monday instead of Tuesday, but you had NO IDEA! This is because there is no real correlation between price and quality when it comes to healthcare.
Another situation where you might find the same surgeon performing the same procedure for two drastically different prices would be when comparing an outpatient surgery with inpatient surgery. First let me explain, outpatient surgery is a surgery where the patient is in the hospital for less than a 24-hr. period. Whereas, an inpatient surgery, the patient stays in the hospital for more than 24 hrs. Now, let’s say patient “x” and patient “y” get the same procedure from the same surgeon on the same day. Both surgeries go well, and they decide to discharge patient “X” who was in the hospital for less than 24 hrs. The bill for patient “x” is based on a percentage charged discount (a discount of a certain percentage decided in a contract with that hospital and patient X’s insurance provider). His bill for an OP surgery could be around $28,000. For whatever reason, the hospital decides they would like to keep Patient “Y” for a few hours longer than planned and Patient “Y” is in the hospital for over a 24-hr. period. Now, the surgery on patient “Y” is billed on a Medical/Surgical day rate or a “per diem.” So, patient Y’s daily rate would be around $2,500. Here, both patient “X” and “Y” received the same surgery from the same surgeon at the same hospital, one patient stayed a couple of hours longer and that bill was reduced by about 91%.
These scenarios can happen often because there is no real correlation between quality and price in healthcare. Both most expensive scenarios above could have been prevented with the inclusion of an experienced and integrated healthcare concierge embedded in the benefits plan.