How Health Care Should Work: Direct-Pay For Well-Priced, High Quality Services
Ah, the dangers of ethnic food! Last week I got a splinter deep in my right thumb while eating delicious souvlaki served on a wooden skewer. Despite my best efforts to get the splinter out I was unable to do so and had to deal with increasing pain and swelling while I was in Mountain View for the Health 2.0 Health:Refactored conference.
Yesterday, I realized the pain was getting worse and that I likely had an infection in the thumb so I decided to do something about it. For the last few years I have had a high-deductible health insurance plan (HDHP), which means I pay for all non-preventive services out of pocket until I hit my deductible of $2,850, at which point the “insurance” part of my plan kicks in to cover the costs. Because I have a HDHP I am very interested in keeping my costs low, but I’m also concerned about getting good quality care and having a positive health experience. As I searched for what to do I realized I had 3 options:
- Emergency Room
- Doctor’s Office
- Urgicare Center
As a physician trained in the great city of New York I knew that option #1 was a non-starter. Going to St. Luke’s, Roosevelt or CPMC for a splinter would guarantee that I’d spend the whole day waiting as the overworked clinical staff dealt with patients with more severe and more pressing medical needs. I also knew that the ER visit would almost certainly also unleash a maelstrom of medical bills after the visit, with none of the charges clearly representing the actual cost of care. With regard to seeing my personal doctor (option #2) I realized that wasn’t an option either. Although I very much like my personal physician and think he does an excellent job providing outpatient care, I know he doesn’t work most weekends and even if I got him on the phone he would have sent me to the local ER anyway.
Given that the ER and my doctor’s office were not options I decided to go with #3, the urgicare center. For those who are not aware, freestanding, privately-owned urgicare centers have popped up all around the city over the last few years. A number of different brands exist, including CityMD, UrgentCare Manhattan, and New York Doctors Urgent Care, among others. I had heard of CityMD before (they advertise on the Yankees radio broadcast) and one of their locations is a few blocks from my apartment, so I decided to go there.
Overall, I would say that my experience was excellent and definitely exceeded my expectations. By point:
- Waiting Time – No appointment necessary. From the time I hit the door, it took less than 15 minutes to be seen by a physician.
- Provider Experience – The ER doc who saw me was competent, nice enough, and most importantly was able to get the 3mm souvlaki skewer sliver out of my thumb.
- Administrative experience – I had to fill out one form when I got there, which took me 2 minutes. Checking out was quick and they accepted payment via Amex.
- Physical Location – The space was large (~5,000 SF), clean and nicely appointed.
The final damage? I was in the office less than 30 minutes. They charged me $125 for the visit, which is what they told me it was going to cost when I called earlier in the day. At my request, the doctor wrote me prescriptions for generic versions of the drugs I needed and I spent $21.72 for an antibiotic pill and antibiotic ointment, and $43.98 for 2 probiotic preparations at the local Walgreens. Total door-to-door time for the whole experience was 60 minutes.
In my view, this is how the health care system should work. High quality health services should be available directly to consumers. You should be able access these services a reasonable price point. You should know how much something is going to cost before you commit to spending your money. The health care experience should be a positive one and should resemble the experiences that we have in other aspects of our lives as consumers. Providers should deliver higher quality patient experience and will do so when they are held accountable by a direct economic relationship with a patient.
Nice work, Team CityMD! I will recommend you to friends and family when they need care.
