Editor's Note: This op-ed previously ran in the Inquirer on May 25, 2014.
If a patient develops a life-threatening complication after a procedure or treatment, should the doctor be paid in full? If a patient is not satisfied with her care or finds her life compromised by the outcome of a procedure, should the provider receive full reimbursement? Currently, our health-care establishment nearly always answers yes to both questions. But is that the correct answer for the health of our nation and the health-care establishment itself?
I feel uniquely qualified to opine in this regard as a surgeon and because of my family's recent personal experience. In October of 2013, my wife underwent a surgical operation, known as morcellation, at one of the top hospitals in our country. As a result of the procedure, which internally broke the tumor into small particles, her early-stage cancer spread and "upstaged" to a life-threatening stage four. We are now fighting the fight of our lives.
Last month, the Food and Drug Administration warned against the use of laparoscopic power morcellation because it "poses a risk of spreading unsuspected cancerous tissue, notably uterine sarcomas, beyond the uterus." The FDA said morcellation can cause the spread of cancers of the uterus at a rate of one in 350 in women with symptomatic fibroids. Yet the gynecological establishment, and many leading hospitals and gynecologists, continue to defend this clearly dangerous practice as being good for the "majority," and thus ethically justified.
Astonishingly, despite being catastrophically affected by this procedure, we continue to receive hospital bills for an operation that compromised our lives on all levels. We are not alone.
Common sense, and even basic marketing etiquette, would suggest that hospitals not send patients bills for procedures that caused severe harm. What if your new automobile blew up within a week of purchase and caused you or your loved one serious injury? Can you imagine the car dealer or bank expecting you to continue making payments? Yet that is almost exactly what happens to thousands of patients each year in the United States. This is a terrible injustice to people who have already taken a hit and may be on the cusp of economic failure as is.
Currently, the formula used to calculate reimbursement fees to doctors and hospitals does not include the patient's voice and experience. The equation includes the doctor or hospital fee and, relatively recently, adjustments using indices for outcomes and quality. Medicare has also attempted to define some errors that will not get reimbursed. But the voice of the patient is nowhere to be found in the reimbursement fee formula. Many experts and physicians believe it is too "complex" a factor to include.
How is it possible that the individual consumer has no direct voice in setting the fair price of a product or service that intimately affects her health and very life?
Giving weight to the patient's voice in the reimbursement formula would help regulate the medical profession by making the patient an empowered participant in the process. It would provide a real-time yardstick for physician performance, ethics, and practice efficacy. An empowered individual patient is a partner in her own care and an active barometer for improving our health-care system. A consumer whose voice is reflected in the price of health care is likely to be a powerful regulatory device in curbing unjustifiable costs.
We have a lopsided health-care marketplace rigged in favor of the seller/supplier and an impersonal intermediary (Medicare, insurance providers, etc.), with an almost totally silenced consumer. This is not only ethically suspect, but a violation of the free-market principles any robust economy needs to thrive.
This problem of the "voiceless consumer" places our health-insurance infrastructure and many families in financial peril. It also compromises medical ethics and the financial motives of physicians and hospitals. The situation allows unfair prices, overt billing, and injustices to persist - cancer upstaging by gynecological morcellation being a rather clear example.
Let's not wait for a major public health catastrophe before we reform out health-care marketplace, giving patients a real and personalized voice in setting a fair-market value of services.
Hooman Noorchashm and Amy Reed, husband-and-wife physicians, have campaigned to ban electric morcellators since December 2013, soon after Reed's unsuspected uterine cancer was spread by the device during a routine hysterectomy.