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New Jersey is Failing Patients : Page 2 of 2

New Jersey is Failing Patients : Page 2 of 2

A fundamental cost driver is physicians that treat a similar patient at a vastly higher cost because they run up the bill with added diagnostics and services in a process called churning.

 

Here is a brief example of responsible care and churned care.

Responsible Care:

Jim had a lesion about the diameter of a pencil eraser on his head that needed to be removed. A doctor removed it in his office in five minutes start to finish including numbing the area with an injection. The cost to insurance was a few hundred dollars.

Churned Care:

Because the pencil eraser sized wound was on his scalp, Jim was sent to a plastic surgeon to close the wound that afternoon to minimize scarring. This process also took less than five minutes from injecting a local anesthetic to the last suture snip - in a full operating room with full sterile drapes in ambulatory surgery center with an anesthesiologist and two nurses. The cost to insurance, thousands. The cost to in deductible and co-insurance, over one thousand. The excuse, "the light was better."

Even when doctors are in-network with an insurer, they can have their way with you, your insurer and your pocketbook. And, insurers pay while regulators look away. Uncovered medical expenses, insured or not, are the leading cause of bankruptcy in the U.S. at 40 percent and as high as 62 percent in New Jersey.

James Doulgeris is the CEO of Osler Health. Osler Health is a statewide clinically collaborative accountable care organization comprised of elite primary care physicians dedicated to setting the high bar for the best care, service and value in New Jersey. 

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