Here is a tale, a tale of two knees.
A Tale of my own knee
Once upon a time, I had some pain in my knee that would not go away. After attempts to rehabilitate it with exercise and then patiently let it recover, I decided to see an orthopedic surgeon. He suggested a cortisone shot and if that didn’t work he could do arthroscopic surgery to repair a presumed torn ligament. The cortisone worked fairly well for a while, but I decided after some time to pursue the surgery. After an MRI, the outpatient surgery was scheduled and successfully performed. A follow-up course of physical therapy was scheduled and completed. At a subsequent appointment with the surgeon, he determined that all was well and the surgery had been a success.
During the whole procedure, all the people were quite nice and helpful. Everything occurred roughly as it was scheduled with no undue delays. In my experience with healthcare, this was one of the more positive experiences I have had, though fairly robotic and impersonal.
When all the bills were received (including charges from many individuals whose names I didn’t recognize and procedures of which I wasn’t sure) the total (prior to any contractual discounts) was something over $20,000. Each part of the procedure and all the prior and follow-up appointments and evaluations were billed individually. Medicare and my supplemental insurance paid essentially everything (after discounts) and all was well. It is important to note that the actually amount paid to the providers for my knee surgery was considerably less than the original billed amount because of contractual discounts – in my case between providers and Medicare.
A Tale of my dog’s knee
About a month after my knee surgery, my dog developed, of all things, a knee problem. Our local veterinarian recommended taking the dog to a veterinary orthopedic specialist for the necessary surgery.
From the moment we walked in the door of the facility our experience was like no other we have ever had. We were warmly welcomed and offered coffee. The facility was new, modern, very clean and efficient. We were seen right away and the veterinarian demonstrated and explained our dog’s problem in detail, what he would do and what the aftercare and recovery would entail. At the front desk, we were asked if we would like a to sign up for a special pet care credit card which would allow us to pay for this surgery interest-free over a year – the woman who made the suggestion coached us through the completion of the application. They also gave us information about pet insurance, but no pressure to sign up. The entire staff was extremely friendly and considerate. The dog was left for the surgery and would stay overnight to recover before coming home.
After the surgery, we received a call that all had gone well. The next morning we received another call that our dog was doing well and ready to go home. When we arrived to pick up our dog we were once again greeted enthusiastically and offered coffee. We went to an examination room where a “nurse” explained for roughly a half hour what had been done and the details of the aftercare for which we would be responsible. She repeatedly said that we should call if there were any questions or concerns. We were provided with instructions and diagrams that clearly explained everything that had been done and we what we would need to do. Next, the doctor came into the room with our dog and he discussed the procedure and talked about how much he loved our dog. Next, a veterinary rehabilitation specialist, who reviewed the physical therapy plan entered the room and taught us how to do the therapy exercises with our dog. She watched us perform the tasks to ensure we were doing things correctly. The therapist was extremely helpful and very gentle but clear in coaching my wife in the details of the physical therapy. She also implored us to call if there were any questions or concerns. She left us with printed materials that explained everything – complete with clear pictures.
Before we left the office, a follow-up appointment was scheduled and the next morning we received a call checking on how our dog was doing. From beginning to end every touch point and interaction was excellent.
You may be wondering how we were billed for all this attention. The invoice arrived, in the name of the doctor who performed the surgery only, and included every service performed for a total of $1800.
While my knee surgery experience was very good, our experience with the dog was phenomenal. Upon reflection, my wife suggested that if I had any further knee problems I should get down on all four and woof – she would take me to those vets for my surgery.
Here is a bone to chew on (pun intended). Why can’t the human healthcare experience be more like my dog’s? Why are their differentials in price and in quality and delivery of services? What do you think?
The puzzle remains – the next time I have a knee problem should I get down on my hands and knees, woof and go to the vet? Why or why not?
David Andrews is co-author of The Patients Prescription