April 2017
Alexa

I recently purchased an Amazon Echo so that Alexa could tell me the answers to life's most perplexing questions.

"Alexa, what time is it?"
"The time is 9:22 am."

"Alexa, how much does an MRI cost?"
"Cost who?"

"Alexa, how much does an MRI cost me, the doctor?"
"Nothing."

"Alexa, how much does an MRI cost my patient?"
"It depends."

"Alexa, on what does the cost of an MRI for my patient depend?"
"Does your patient have insurance?"

"Alexa, what is the cost of an MRI for my patient who has no insurance?"
"Nothing, because he probably won't get it."

"Alexa, what is the cost of an MRI for my patient if he has insurance?"
"It depends."

"Alexa, on what does the cost of an MRI for my patient with insurance depend?"

"The cost of an MRI for your patient with insurance depends on your patient's age, gender, insurance company, the type of insurance policy with that company, his deductible and whether he has met his deductible, whether the study will be as an outpatient or inpatient, the site where the MRI is done, the month of the year, the day of the week, the hour of the day, the current weather, the color blue, ...."

"Alexa, stop!"

"Alexa, it is 9:45 am on Friday, March 23, 2017. It is 58 degrees and cloudy. My patient is a two-month-old premature male infant. His parents have the best insurance policy from the best insurance company. His parents have paid none of the $5,000 deductible.  The MRI will be scheduled as an outpatient and the color is blue. Where can my patient get the cheapest MRI?"

"I do not have enough information to answer that question because you interrupted me. But, your patient might try Dubai. Expedia.com has some cheap travel packages this time of year and children stay for free."

Last month I was discharging a premature infant from the hospital and I ordered an MRI to be done one month post-discharge to assess for periventricular leukomalacia, a predictor of cerebral palsy. I realized I had no idea how much the study would cost this young family, nor did I have an easy, efficient and dependable way to find out. If I really wanted to know, I could have called around to each of the 21 medical providers in Louisville who provide MRIs. 

Or, I could have called my patient's insurance company to find out how much it would pay for an MRI at in-network and out-of-network sites. Or, I could have gone to the Kentucky Cabinet for Health and Family Resources which, by the 2015 revised Kentucky Statute 216.2929, is required to "prepare and publish, in understandable language with sufficient explanation to allow consumers to draw meaningful comparisons, a report on health care charges, quality and outcomes that includes diagnosis-specific or procedure-specific comparisons for each hospital and ambulatory facility." But I didn't do any of these things because none seemed easy, efficient or dependable.

Later in the day I was booking my travel to Washington, DC. I shopped around on one single website. Eventually, I booked my airline ticket with a specific airline, for a specific seat on a specific day, at a specific time, for a specific cost. I provided my frequent flyer number to earn points for the time in the future I would use the same airline. I provided my credit card number and paid for the flight. From the website I was linked to a car rental company of my choosing, and I booked the car of my choice based on how much I was willing to spend. I declined the extra insurance coverage because my personal auto insurance covered some of the contingencies and I have the personal resources to cover others if something bad happened. I provided my AMA membership information and received a discounted rate. I provided my credit card number and paid for the car rental. Then, from the same website, I was directed to the hotel of my choosing. I provided my hotel loyalty rewards number and the site suggested the type of room I usually book. I chose it and the number of days I wished to stay and whether I wanted the continental breakfast and daily newspaper. When I finished all this booking I knew what I was getting, when I would get it and what it would cost. The whole process took 20 minutes. I had confidence that in a month my trip would go well. Following my trip, I will have the opportunity to "grade" each of these services so that others can learn from my experiences. This is how things are supposed to work!

Why can't our health care system work like this? 

I hope you are in communication with your congressmen about our health care system. While we are repealing, replacing or repairing our health care law, wouldn't it be an opportune time to redesign our health care system?

"Alexa, what time is it now?" 

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