Think Twice Before You Bargain Hunt for Health Procedures Online
Digital Tools for Health Come With 'Hope, Hype and Harm'
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Some sites – like \u003ca href=\"http://www.priceline.com/home/\">Priceline \u003c/a>- even let you do the online version of haggling: You name the price you're willing to pay and the site matches you with a hotel willing to accept your bid.\u003c/p>\n\u003cp>Some entrepreneurs are now trying to adapt this approach to the health care field, where it's been notoriously difficult to shop around. It's a development that's being welcomed – with some caution – by people who advocate for transparency in the health care marketplace.\u003c/p>\n\u003cp>\"This approach is the type of thing that the health care market needs,\" says Dr. Peter Ubel, a professor at Duke University. \"With more and more people in the U.S. paying more and more out of pocket for their health care, they need to be more like regular consumers, where they're looking around for price and quality.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Overall, these new sites that bill themselves as being like Priceline for health care \"give consumers more power,\" Ubel says. But, he and others warn, with more power comes more responsibility on the part of the consumer.\u003c/p>\n\u003cp>\u003cstrong>A Win-Win\u003c/strong>\u003c/p>\n\u003cp>Take the Los Angeles-based start-up company\u003ca href=\"https://www.zendyhealth.com/\"> ZendyHealth\u003c/a>.\u003c/p>\n\u003cp>The site allows you to choose a procedure from a list of medical services, like CT or MRI scans. It will tell you the average price for that procedure. You can then suggest the price that you're willing to pay, and providers can choose whether to accept the bid. If you undergo the procedure, you can either pay in cash or use funds from your health savings account, if you have a high-deductible health plan.\u003c/p>\n\u003cp>Another site, \u003ca href=\"http://www.medibid.com/\">MediBid\u003c/a>, lets you post a request for a procedure. Doctors and facilities can then bid on your request.\u003c/p>\n\u003cp>Dr. Vish Banthia, with more than 10 years of experience in head and neck surgery, as well as facial, plastic and reconstructive surgery, is ZendyHealth's chief medical officer. He says he developed the site in response to two problems he'd repeatedly witnessed: Patients were sometimes\u003ca href=\"http://www.scpr.org/blogs/health/2015/05/14/18029/high-deductibles-force-people-to-skip-care-study-f/\"> skipping recommended tests or treatments\u003c/a> because they couldn't afford them. Meanwhile, he says, providers were facing the high costs of staying in business.\u003c/p>\n\u003cp>ZendyHealth, then, is a win-win for patients and providers, he says: Patients can get a deal on certain procedures and providers can try to fill their appointment slots.\u003c/p>\n\u003cp>\"A patient can't input a ridiculously low amount, and of course providers have the right to not accept these prices if it doesn't make sense for them,\" Banthia says. But \"for most of the requests that are being made by the customers on our site, we're able to fulfill them because it makes sense for the provider to accept.\"\u003c/p>\n\u003cp>\u003cstrong>Comparison Shopping \u003c/strong>\u003c/p>\n\u003cp>The experts I spoke with for this story agree that consumers should be cautious when using these types of tools to shop for health care. In fact, they say, there are several steps consumers should take before using one of these sites.\u003c/p>\n\u003cp>Say your doctor is recommending you get an MRI scan. First, experts say, it's worth finding out how much the procedure should cost in your area.\u003c/p>\n\u003cp>If you have insurance, start by checking with your insurance company how much the procedure would cost if you went through your plan. It's also a good idea to check sites like \u003ca href=\"https://www.healthcarebluebook.com/page_Default.aspx\">Healthcare Bluebook\u003c/a>, which estimate the price of procedures in your area, or KPCC's and KQED's \u003ca href=\"http://www.scpr.org/price-check\">PriceCheck\u003c/a>, which shows the range of prices charged by facilities in your area, what patients have paid and what insurers have covered.\u003c/p>\n\u003cp>After doing that research, you could check out sites like ZendyHealth or MediBid to see if they offer deeper discounts.\u003c/p>\n\u003cp>\"If it really looks like from one of these sites that the deal might be better, then you might be able to go in with eyes wider open,\" says Suzanne Delbanco, executive director of\u003ca href=\"http://www.catalyzepaymentreform.org/\"> Catalyst for Payment Reform\u003c/a>, which works on behalf of large employers and other health care purchasers to promote higher-value care in the U.S.\u003c/p>\n\u003cp>\"I would certainly do some comparison shopping before assuming that these sites are offering something better than you might get through the normal means,\" she adds.\u003c/p>\n\u003cp>\u003cstrong>'Price Isn't Everything' \u003c/strong>\u003c/p>\n\u003cp>Experts stress that bargain hunting for medical care is a complex endeavor: When shopping for health care, consumers should not just consider price, but also the quality of the facility, its doctors and the services provided.\u003c/p>\n\u003cp>\"Price isn't everything,\" Ubel says. \"Sometimes you can pay too little for something and end up with something that's very low quality.\"\u003c/p>\n\u003cp>So how do you know if that bargain MRI is worth it?\u003c/p>\n\u003cp>Leah Binder, president and CEO of the \u003ca href=\"http://www.leapfroggroup.org/\">Leapfrog Group\u003c/a>, recommends doing your due diligence by asking for a facility's infection rates, requesting documentation of its board certification and licensure, and researching other quality measures.\u003c/p>\n\u003cp>\"Try to get some confirmation that this provider is good,\" Binder says. \"That's a very critical element – you're entrusting your health and life to this person, so you need to know that they can do a good job for you.\"\u003c/p>\n\u003cp>On its website, ZendyHealth says it has a Medical Advisory Board that screens for top class, highly rated, certified providers and selectively adds them to its provider network.\u003c/p>\n\u003cp>Binder still has concerns about who might end up being listed on these types of sites.\u003c/p>\n\u003cp>\"We don't know who is going to put their services out into a market like this - it could be some fraudulent providers, it could be some very bad providers who can't get business elsewhere, so we certainly have to be afraid of that,\" Binder says.\u003c/p>\n\u003cp>\"On the other hand, I'm hopeful that it's a sign that we're going to change the way consumers access health care,\" she says. \"As soon as consumers are out there looking at both price and quality and making deliberate decisions about providers based on those things, we will change the way health care is delivered. It will change everything.\"\u003c/p>\n\u003cp>Banthia of ZendyHealth points out that his company isn't trying to encourage people to shop around for cheaper prices for care, \"we're just simply taking the entire process of what's been going on between patients and providers and making it more efficient.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Have you tried negotiating the cost of your health care? Tell us about your experience in the comments section below or email Impatient@scpr.org.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Consumers should be cautious when using new online tools to shop for health care, experts say. ","status":"publish","parent":0,"modified":1477280067,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":1124},"headData":{"title":"Think Twice Before You Bargain Hunt for Health Procedures Online | KQED","description":"Consumers should be cautious when using new online tools to shop for health care, experts say. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"22981 http://ww2.kqed.org/futureofyou/?p=22981","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/08/10/think-twice-before-you-bargain-hunt-for-health-care-procedures/","disqusTitle":"Think Twice Before You Bargain Hunt for Health Procedures Online","nprByline":"Rebecca Plevin, KPCC","path":"/futureofyou/22981/think-twice-before-you-bargain-hunt-for-health-care-procedures","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://www.scpr.org/blogs/health/2015/08/05/18054/bargain-hunt-for-health-care-procedures-but-use-ca/\">This post originally appeared on KPCC’s consumer health blog, Impatient.\u003c/a>\u003c/p>\n\u003cp>Shopping for things like hotel reservations is pretty easy these days.\u003c/p>\n\u003cp>There are a lot of websites that allow you to compare options by price and other factors. Some sites – like \u003ca href=\"http://www.priceline.com/home/\">Priceline \u003c/a>- even let you do the online version of haggling: You name the price you're willing to pay and the site matches you with a hotel willing to accept your bid.\u003c/p>\n\u003cp>Some entrepreneurs are now trying to adapt this approach to the health care field, where it's been notoriously difficult to shop around. It's a development that's being welcomed – with some caution – by people who advocate for transparency in the health care marketplace.\u003c/p>\n\u003cp>\"This approach is the type of thing that the health care market needs,\" says Dr. Peter Ubel, a professor at Duke University. \"With more and more people in the U.S. paying more and more out of pocket for their health care, they need to be more like regular consumers, where they're looking around for price and quality.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, these new sites that bill themselves as being like Priceline for health care \"give consumers more power,\" Ubel says. But, he and others warn, with more power comes more responsibility on the part of the consumer.\u003c/p>\n\u003cp>\u003cstrong>A Win-Win\u003c/strong>\u003c/p>\n\u003cp>Take the Los Angeles-based start-up company\u003ca href=\"https://www.zendyhealth.com/\"> ZendyHealth\u003c/a>.\u003c/p>\n\u003cp>The site allows you to choose a procedure from a list of medical services, like CT or MRI scans. It will tell you the average price for that procedure. You can then suggest the price that you're willing to pay, and providers can choose whether to accept the bid. If you undergo the procedure, you can either pay in cash or use funds from your health savings account, if you have a high-deductible health plan.\u003c/p>\n\u003cp>Another site, \u003ca href=\"http://www.medibid.com/\">MediBid\u003c/a>, lets you post a request for a procedure. Doctors and facilities can then bid on your request.\u003c/p>\n\u003cp>Dr. Vish Banthia, with more than 10 years of experience in head and neck surgery, as well as facial, plastic and reconstructive surgery, is ZendyHealth's chief medical officer. He says he developed the site in response to two problems he'd repeatedly witnessed: Patients were sometimes\u003ca href=\"http://www.scpr.org/blogs/health/2015/05/14/18029/high-deductibles-force-people-to-skip-care-study-f/\"> skipping recommended tests or treatments\u003c/a> because they couldn't afford them. Meanwhile, he says, providers were facing the high costs of staying in business.\u003c/p>\n\u003cp>ZendyHealth, then, is a win-win for patients and providers, he says: Patients can get a deal on certain procedures and providers can try to fill their appointment slots.\u003c/p>\n\u003cp>\"A patient can't input a ridiculously low amount, and of course providers have the right to not accept these prices if it doesn't make sense for them,\" Banthia says. But \"for most of the requests that are being made by the customers on our site, we're able to fulfill them because it makes sense for the provider to accept.\"\u003c/p>\n\u003cp>\u003cstrong>Comparison Shopping \u003c/strong>\u003c/p>\n\u003cp>The experts I spoke with for this story agree that consumers should be cautious when using these types of tools to shop for health care. In fact, they say, there are several steps consumers should take before using one of these sites.\u003c/p>\n\u003cp>Say your doctor is recommending you get an MRI scan. First, experts say, it's worth finding out how much the procedure should cost in your area.\u003c/p>\n\u003cp>If you have insurance, start by checking with your insurance company how much the procedure would cost if you went through your plan. It's also a good idea to check sites like \u003ca href=\"https://www.healthcarebluebook.com/page_Default.aspx\">Healthcare Bluebook\u003c/a>, which estimate the price of procedures in your area, or KPCC's and KQED's \u003ca href=\"http://www.scpr.org/price-check\">PriceCheck\u003c/a>, which shows the range of prices charged by facilities in your area, what patients have paid and what insurers have covered.\u003c/p>\n\u003cp>After doing that research, you could check out sites like ZendyHealth or MediBid to see if they offer deeper discounts.\u003c/p>\n\u003cp>\"If it really looks like from one of these sites that the deal might be better, then you might be able to go in with eyes wider open,\" says Suzanne Delbanco, executive director of\u003ca href=\"http://www.catalyzepaymentreform.org/\"> Catalyst for Payment Reform\u003c/a>, which works on behalf of large employers and other health care purchasers to promote higher-value care in the U.S.\u003c/p>\n\u003cp>\"I would certainly do some comparison shopping before assuming that these sites are offering something better than you might get through the normal means,\" she adds.\u003c/p>\n\u003cp>\u003cstrong>'Price Isn't Everything' \u003c/strong>\u003c/p>\n\u003cp>Experts stress that bargain hunting for medical care is a complex endeavor: When shopping for health care, consumers should not just consider price, but also the quality of the facility, its doctors and the services provided.\u003c/p>\n\u003cp>\"Price isn't everything,\" Ubel says. \"Sometimes you can pay too little for something and end up with something that's very low quality.\"\u003c/p>\n\u003cp>So how do you know if that bargain MRI is worth it?\u003c/p>\n\u003cp>Leah Binder, president and CEO of the \u003ca href=\"http://www.leapfroggroup.org/\">Leapfrog Group\u003c/a>, recommends doing your due diligence by asking for a facility's infection rates, requesting documentation of its board certification and licensure, and researching other quality measures.\u003c/p>\n\u003cp>\"Try to get some confirmation that this provider is good,\" Binder says. \"That's a very critical element – you're entrusting your health and life to this person, so you need to know that they can do a good job for you.\"\u003c/p>\n\u003cp>On its website, ZendyHealth says it has a Medical Advisory Board that screens for top class, highly rated, certified providers and selectively adds them to its provider network.\u003c/p>\n\u003cp>Binder still has concerns about who might end up being listed on these types of sites.\u003c/p>\n\u003cp>\"We don't know who is going to put their services out into a market like this - it could be some fraudulent providers, it could be some very bad providers who can't get business elsewhere, so we certainly have to be afraid of that,\" Binder says.\u003c/p>\n\u003cp>\"On the other hand, I'm hopeful that it's a sign that we're going to change the way consumers access health care,\" she says. \"As soon as consumers are out there looking at both price and quality and making deliberate decisions about providers based on those things, we will change the way health care is delivered. It will change everything.\"\u003c/p>\n\u003cp>Banthia of ZendyHealth points out that his company isn't trying to encourage people to shop around for cheaper prices for care, \"we're just simply taking the entire process of what's been going on between patients and providers and making it more efficient.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Have you tried negotiating the cost of your health care? Tell us about your experience in the comments section below or email Impatient@scpr.org.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/22981/think-twice-before-you-bargain-hunt-for-health-care-procedures","authors":["byline_futureofyou_22981"],"categories":["futureofyou_1060"],"tags":["futureofyou_554","futureofyou_193","futureofyou_34","futureofyou_80"],"featImg":"futureofyou_23001","label":"futureofyou"},"futureofyou_1710":{"type":"posts","id":"futureofyou_1710","meta":{"index":"posts_1591205157","site":"futureofyou","id":"1710","score":null,"sort":[1429030909000]},"guestAuthors":[],"slug":"digital-tools-for-health-come-with-hope-hype-and-harm","title":"Digital Tools for Health Come With 'Hope, Hype and Harm'","publishDate":1429030909,"format":"standard","headTitle":"Future of You | KQED Future of You | KQED Science","labelTerm":{"term":54,"site":"futureofyou"},"content":"\u003cp>Dr. Robert Wachter has long been an advocate for patient safety and a keen observer of trends in medicine.\u003c/p>\n\u003cp>Years ago, Wachter coined the term \"\u003ca href=\"http://www.hospitalmedicine.org/Web/About_SHM/Industry/Hospital_Medicine_Hospital_Definition.aspx\">hospitalist\u003c/a>\" and predicted the rise of these doctors who specialize in caring for hospitalized patients.\u003c/p>\n\u003cp>Wachter, associate chairman of University of California, San Francisco's department of medicine, has a new book out: \u003cem>\u003ca href=\"http://www.amazon.com/dp/0071849467/\">The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age\u003c/a>. \u003c/em>In it, he turns his attention to the rise of technology in health care, and the risks and rewards as we digitize everything from medical records to office visits. Here is an edited and condensed version of our recent conversation about it.\u003c/p>\n\u003cp>\u003cstrong>As I read your book I couldn't help thinking about the elderly. Many older people aren't tech savvy. They're intimidated by looking up information on computers and sending email to their doctors. They're also bigger health care users than many younger people. What needs to be done to help them get and stay engaged as technology advances?\u003c/strong>\u003c/p>\n\u003cp>It's an important question. It's not natural for them the way it is for the next generation and beyond. But most older people are at least using email and know how to surf the Web. Silicon Valley has woken up and realized this is a huge market. As consumer-oriented tech companies enter the health care field, I think they're going to design tools and technology and ways of interfacing that make it seamless for the people who need to become engaged. This will allow older patients to at least do the basic stuff, like renewing their medications, the stuff that's just incredibly annoying in the paper world.\u003c/p>\n\u003cfigure id=\"attachment_1711\" class=\"wp-caption alignright\" style=\"max-width: 313px\">\u003cimg class=\" wp-image-1711\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7.jpg\" alt=\"Dr. Robert Wachter writes that computers have crowded out eye contact between the doctor and patient, in his latest book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.\" width=\"313\" height=\"457\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7.jpg 799w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7-400x584.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7-411x600.jpg 411w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7-768x1121.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7-320x467.jpg 320w\" sizes=\"(max-width: 313px) 100vw, 313px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Robert Wachter writes that computers have crowded out eye contact between the doctor and patient, in his latest book, \u003cem>The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.\u003c/em> \u003ccite>(Susan Merrell/University of California, San Francisco)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>In your book, you talk about moving away from fee-for-service payments to doctors and hospitals and toward payments based on a population of people, adjusted for their baseline health. From a patient perspective, will that change how they pay for their care? At the most basic level, could that finally mean the end of incomprehensible \"explanation of benefits\" insurance forms, for example? \u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>I wish I were more hopeful. Of all the nuts we have to crack, this is the one I'm least optimistic about.\u003c/p>\n\u003cp>If everybody is in an accountable care organization or the like, providers get a single payment when they treat someone. But as long as they're still doing an adjustment for the relative sickness of the patients, the organization will need to account for all of the details. And I'm afraid the patient may also still see a confusing itemized bill, unless we can get to a point in which you've paid for the year and you're done.\u003c/p>\n\u003cp>The movement away from piecemeal payments is hopeful, and so are the digitization of health care and the entry of Silicon Valley companies with a consumer sensibility. I guess the question is: Do all of those trends — when woven together — lead to something that's more user friendly? When it comes to clinical care, I think the answer is yes. I see how we can get to a much happier place, with better care through digital medicine, in five to seven years. But the idea that you could get a simple, clear insurance bill that you pay with one click... that still feels like a moon shot to me. So maybe in 10 to 15 years.\u003c/p>\n\u003cp>\u003cstrong>To what extent can technology really help people comparison shop for health care? To date, we've seen that it seems to work best for procedures like colonoscopies or MRIs, where the service performed is fairly comparable. Could people really comparison shop for cancer treatment? Would we want them to?\u003c/strong>\u003c/p>\n\u003cp>Sure, why not? Some of this comes down to your fundamental belief in capitalism and the market. But we do have to pay some attention to fundamental differences between health care and other markets. For example, in health care, we can't accept haves and have-nots, while we readily accept this with other luxury goods. That said, I'm pretty convinced that if you create an environment where patients have the information they need to make those decisions, that the market will help them make good choices.\u003c/p>\n\u003cp>The area I worry about is the science. How do we really know that one doctor or hospital is better than another? Most aspects of quality measurement are not very advanced.\u003c/p>\n\u003cp>Another real challenge is fragmentation. If I get my colonoscopy at one place because it's the best and cheapest but it's in a different system than the one my primary care doctor is in, that's a problem if the electronic records don't talk to each other. As a patient, I've got to think about the advantage of receiving the cheapest procedure compared to the negative consequences of no one doctor having a complete view of my health.\u003c/p>\n\u003cp>\u003cstrong>Do you think the federal health law requirement that people have health insurance positively affects their engagement in their own health care or the health care system?\u003c/strong>\u003c/p>\n\u003cp>I think everybody should have health insurance. The system works better and people have better health and health care with universal insurance. And the law was the most politically feasible way to make that happen, so I support it. When people have health insurance, it creates a connection to a system that is largely mediated through a primary care doctor. To have 40 to 50 million people floating outside the system – able to access the system only episodically and when they're very ill – is crazy.\u003c/p>\n\u003cp>Has having insurance increased their engagement? Yes, but at a level that's pretty wimpy. Now you can see a primary care doctor to manage your blood pressure in an office visit every six months, but is that the level of engagement we should aspire to? Nowhere near it. The hope is that by having everybody part of an organized health care system, now it's in the interest of the system to have engaged patients – since that engagement should lead to fewer office visits, ER visits, and hospitalizations. But this is the sort of thing that takes years, if not decades, to develop.\u003c/p>\n\u003cp>\u003cstrong>What about initiatives like OpenNotes that allow patients to read their doctors' electronic notes about their care? How do they change the patient-doctor relationship?\u003c/strong>\u003c/p>\n\u003cp>OpenNotes illustrates the democratization of the health care system, which is going to challenge all of the system's fundamental underpinnings. Digitization is an enabler. It's changing the relationship between doctors and their patients from an extraordinarily paternalistic one to one that is more democratic. In the new world, a patient's choice is no longer just, \"Do I see doctor A or B?\" but \"Do I even need to see a doctor at all?\" OpenNotes is part of this trend.\u003c/p>\n\u003cp>As wonderful as patient sharing access to their information is, along with new tools to self-manage and things like telemedicine that allow patients to receive care outside the traditional system, in a world of high copays you are going to see some patients making some very bad choices. In the old days, the sick patient had to go see a doctor. Now they can go to MinuteClinic. Or they can Google their symptoms. I wouldn't want to turn back the clock, but it raises the question, \"When is self-management a bad choice?\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>As health care finally goes digital, some people believe that it's no different than travel or banking. But no one is getting harmed by using TripAdvisor or Fidelity. I think you could argue that health care is fundamentally different.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">http://www.kaiserhealthnews.org/\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Digital+Tools+For+Health+Come+With+%27Hope%2C+Hype+And+Harm%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"Medicine's move into the computer age has great potential for improving care. But patients and doctors still face serious challenges in adapting to the rush of new technology.","status":"publish","parent":0,"modified":1517012664,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":1346},"headData":{"title":"Digital Tools for Health Come With 'Hope, Hype and Harm' | KQED","description":"Medicine's move into the computer age has great potential for improving care. But patients and doctors still face serious challenges in adapting to the rush of new technology.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"1710 http://ww2.kqed.org/futureofyou/?p=1710","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/04/14/digital-tools-for-health-come-with-hope-hype-and-harm/","disqusTitle":"Digital Tools for Health Come With 'Hope, Hype and Harm'","nprByline":"Michelle Andrews","nprStoryId":"399423844","nprApiLink":"http://api.npr.org/query?id=399423844&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/blogs/health/2015/04/14/399423844/digital-tools-for-health-come-with-hope-hype-and-harm?ft=nprml&f=399423844","nprRetrievedStory":"1","nprPubDate":"Tue, 14 Apr 2015 12:09:00 -0400","nprStoryDate":"Tue, 14 Apr 2015 10:51:00 -0400","nprLastModifiedDate":"Tue, 14 Apr 2015 12:09:12 -0400","path":"/futureofyou/1710/digital-tools-for-health-come-with-hope-hype-and-harm","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Robert Wachter has long been an advocate for patient safety and a keen observer of trends in medicine.\u003c/p>\n\u003cp>Years ago, Wachter coined the term \"\u003ca href=\"http://www.hospitalmedicine.org/Web/About_SHM/Industry/Hospital_Medicine_Hospital_Definition.aspx\">hospitalist\u003c/a>\" and predicted the rise of these doctors who specialize in caring for hospitalized patients.\u003c/p>\n\u003cp>Wachter, associate chairman of University of California, San Francisco's department of medicine, has a new book out: \u003cem>\u003ca href=\"http://www.amazon.com/dp/0071849467/\">The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age\u003c/a>. \u003c/em>In it, he turns his attention to the rise of technology in health care, and the risks and rewards as we digitize everything from medical records to office visits. Here is an edited and condensed version of our recent conversation about it.\u003c/p>\n\u003cp>\u003cstrong>As I read your book I couldn't help thinking about the elderly. Many older people aren't tech savvy. They're intimidated by looking up information on computers and sending email to their doctors. They're also bigger health care users than many younger people. What needs to be done to help them get and stay engaged as technology advances?\u003c/strong>\u003c/p>\n\u003cp>It's an important question. It's not natural for them the way it is for the next generation and beyond. But most older people are at least using email and know how to surf the Web. Silicon Valley has woken up and realized this is a huge market. As consumer-oriented tech companies enter the health care field, I think they're going to design tools and technology and ways of interfacing that make it seamless for the people who need to become engaged. This will allow older patients to at least do the basic stuff, like renewing their medications, the stuff that's just incredibly annoying in the paper world.\u003c/p>\n\u003cfigure id=\"attachment_1711\" class=\"wp-caption alignright\" style=\"max-width: 313px\">\u003cimg class=\" wp-image-1711\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7.jpg\" alt=\"Dr. Robert Wachter writes that computers have crowded out eye contact between the doctor and patient, in his latest book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.\" width=\"313\" height=\"457\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7.jpg 799w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7-400x584.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7-411x600.jpg 411w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7-768x1121.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/wachter-2_enl-1940c2d5c1865e3563ca9ee326e802aa12d934c7-320x467.jpg 320w\" sizes=\"(max-width: 313px) 100vw, 313px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Robert Wachter writes that computers have crowded out eye contact between the doctor and patient, in his latest book, \u003cem>The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.\u003c/em> \u003ccite>(Susan Merrell/University of California, San Francisco)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>In your book, you talk about moving away from fee-for-service payments to doctors and hospitals and toward payments based on a population of people, adjusted for their baseline health. From a patient perspective, will that change how they pay for their care? At the most basic level, could that finally mean the end of incomprehensible \"explanation of benefits\" insurance forms, for example? \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I wish I were more hopeful. Of all the nuts we have to crack, this is the one I'm least optimistic about.\u003c/p>\n\u003cp>If everybody is in an accountable care organization or the like, providers get a single payment when they treat someone. But as long as they're still doing an adjustment for the relative sickness of the patients, the organization will need to account for all of the details. And I'm afraid the patient may also still see a confusing itemized bill, unless we can get to a point in which you've paid for the year and you're done.\u003c/p>\n\u003cp>The movement away from piecemeal payments is hopeful, and so are the digitization of health care and the entry of Silicon Valley companies with a consumer sensibility. I guess the question is: Do all of those trends — when woven together — lead to something that's more user friendly? When it comes to clinical care, I think the answer is yes. I see how we can get to a much happier place, with better care through digital medicine, in five to seven years. But the idea that you could get a simple, clear insurance bill that you pay with one click... that still feels like a moon shot to me. So maybe in 10 to 15 years.\u003c/p>\n\u003cp>\u003cstrong>To what extent can technology really help people comparison shop for health care? To date, we've seen that it seems to work best for procedures like colonoscopies or MRIs, where the service performed is fairly comparable. Could people really comparison shop for cancer treatment? Would we want them to?\u003c/strong>\u003c/p>\n\u003cp>Sure, why not? Some of this comes down to your fundamental belief in capitalism and the market. But we do have to pay some attention to fundamental differences between health care and other markets. For example, in health care, we can't accept haves and have-nots, while we readily accept this with other luxury goods. That said, I'm pretty convinced that if you create an environment where patients have the information they need to make those decisions, that the market will help them make good choices.\u003c/p>\n\u003cp>The area I worry about is the science. How do we really know that one doctor or hospital is better than another? Most aspects of quality measurement are not very advanced.\u003c/p>\n\u003cp>Another real challenge is fragmentation. If I get my colonoscopy at one place because it's the best and cheapest but it's in a different system than the one my primary care doctor is in, that's a problem if the electronic records don't talk to each other. As a patient, I've got to think about the advantage of receiving the cheapest procedure compared to the negative consequences of no one doctor having a complete view of my health.\u003c/p>\n\u003cp>\u003cstrong>Do you think the federal health law requirement that people have health insurance positively affects their engagement in their own health care or the health care system?\u003c/strong>\u003c/p>\n\u003cp>I think everybody should have health insurance. The system works better and people have better health and health care with universal insurance. And the law was the most politically feasible way to make that happen, so I support it. When people have health insurance, it creates a connection to a system that is largely mediated through a primary care doctor. To have 40 to 50 million people floating outside the system – able to access the system only episodically and when they're very ill – is crazy.\u003c/p>\n\u003cp>Has having insurance increased their engagement? Yes, but at a level that's pretty wimpy. Now you can see a primary care doctor to manage your blood pressure in an office visit every six months, but is that the level of engagement we should aspire to? Nowhere near it. The hope is that by having everybody part of an organized health care system, now it's in the interest of the system to have engaged patients – since that engagement should lead to fewer office visits, ER visits, and hospitalizations. But this is the sort of thing that takes years, if not decades, to develop.\u003c/p>\n\u003cp>\u003cstrong>What about initiatives like OpenNotes that allow patients to read their doctors' electronic notes about their care? How do they change the patient-doctor relationship?\u003c/strong>\u003c/p>\n\u003cp>OpenNotes illustrates the democratization of the health care system, which is going to challenge all of the system's fundamental underpinnings. Digitization is an enabler. It's changing the relationship between doctors and their patients from an extraordinarily paternalistic one to one that is more democratic. In the new world, a patient's choice is no longer just, \"Do I see doctor A or B?\" but \"Do I even need to see a doctor at all?\" OpenNotes is part of this trend.\u003c/p>\n\u003cp>As wonderful as patient sharing access to their information is, along with new tools to self-manage and things like telemedicine that allow patients to receive care outside the traditional system, in a world of high copays you are going to see some patients making some very bad choices. In the old days, the sick patient had to go see a doctor. Now they can go to MinuteClinic. Or they can Google their symptoms. I wouldn't want to turn back the clock, but it raises the question, \"When is self-management a bad choice?\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As health care finally goes digital, some people believe that it's no different than travel or banking. But no one is getting harmed by using TripAdvisor or Fidelity. I think you could argue that health care is fundamentally different.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">http://www.kaiserhealthnews.org/\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Digital+Tools+For+Health+Come+With+%27Hope%2C+Hype+And+Harm%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/1710/digital-tools-for-health-come-with-hope-hype-and-harm","authors":["byline_futureofyou_1710"],"programs":["futureofyou_54"],"categories":["futureofyou_1"],"tags":["futureofyou_193","futureofyou_26","futureofyou_190","futureofyou_192","futureofyou_34","futureofyou_61","futureofyou_80","futureofyou_85","futureofyou_125","futureofyou_189","futureofyou_35"],"featImg":"futureofyou_1715","label":"futureofyou_54"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. 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Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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