However, not all circumstances are so easily addressed. In particular, the health care industry does not provide such clear signals as the fast food industry as to where clients needs to go in order to get their needs and wants addressed. Health care services are generally offered without menus. There are exceptions to this rule. The retail clinics post their menus and their prices. This does not stop patients from trying to order off the menu, looking for a convenient place to seek help for acute chest pain, acute fractures, or anaphylaxis. We try to inform people what is clearly off the menu. If I call my physician (of virtually any sort), the first thing I hear is the opening message of the phone tree. It tells me that if I have an acute and life threatening problem I should hang up the phone and call 911. That is simply not on the menu of services offered and that is made clear right up front. It is one of the only things made clear in terms of services offered or encouraged.
There is a master menu of covered medical services but the public is not really aware of its presence. There are rarely defined prices linked. It is called the CPT (Current Procedural Terminology) code book. It is owned by the AMA which makes a handsome sum of money licensing these. At first it appears there are a dizzying number of codes, over 7500, corresponding to some medical service which gets charged. The numbers may seem large but let's compare restaurant menus to medical menus.
The CPT codes have changed only modestly over the past 30 years. There are new ones approved but the lion's share of codes in existence now were the same as when I trained long ago. Compare that to the food and restaurant business. Think of all of the cuisines which essentially unheard of in this country 30 years ago. The menus of the food business have exploded. We have new cuisines and expansion of old cuisines. In contrast, the menus of the health care field has stagnated. Everybody uses the same ones. The prices are set administratively. We have access to new high profile drugs and high tech equipment but the ability of the industry to better address individual patient wants and needs has gone essentially nowhere.Review the process to get codes added or changed and you can see why.
How are requests for changes to CPT reviewed?
CPT is a menu which is not for patients, but for those providing the services. The reality is there are no readily accessible menus for patients because the options developed are not about what patients want. They focus on what the experts believe that patient need, a perception strongly influenced by the financial interests of those vested in the current system. Patient choice and empowerment may sound good but they are not really on the table. Create an environment to reward patients who control their own resources and menus with prices will come quickly. So will new menu offerings.