Become an empowered patient

Higher-deductible health insurance plans are becoming more popular among large companies as a way of limiting their own health-care expenses. That means higher out-of-pocket cost for health care is becoming the new normal.

Is there anything financial advisors can do to help clients stem the outflow?

health care costs
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Fortunately, there are a number of tools that can control costs, and it all starts with being an empowered patient. Your clients' involvement in each step of their diagnoses and treatments can significantly impact the cost of their health care.

Here is some advice I offer clients, so they can take a more proactive approach to offsetting health-care expenses.

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Write down your health history

Most illnesses can be diagnosed by the story alone. If the doctor has the right story, most often they can quickly make a diagnosis and start the patient on the path of wellness.

Two factors have severely eaten into the time a doctor can spend getting the patient story: the need to see too many patients and the use of electronic health records.

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Entering information into an electronic health record is time consuming, and that eats into the time the doctor has to talk with the patient. With the lack of time to listen, doctors sometimes "railroad" the patient into a story and diagnosis.

If they get the story wrong, the patient is sent down a path of tests and treatment that may be unnecessary, harmful and expensive. The key is to make certain they get the correct story from the beginning.

How can your clients do this?

Simply tell them to write their stories down. Start with every detail of how and when the problem began and what they did to try to feel better. Have them list every medicine they take, their family history and any lifestyle factors that may be involved.

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Have them make two copies of the narrative—one to give to the nurse before the doctor sees the client, and one for reference during the time the doctor is with the client. If the doctor starts peppering the client with questions that were addressed in the history he or she provided, ask if the doctor read the narrative. If not, the client should kindly ask the doctor to read it before proceeding with further questions.

Monitor the physical

It may sound obvious, but examining the body is the next step in obtaining the correct diagnosis.

Make certain the doctor looks at the affected part. Doctors "code" a visit based on how extensive a history and physical they perform. The higher the code, the more expensive the visit will be.

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If a problem is simple, such as a sprain or skin rash, the exam shouldn't be extensive. If the doctor begins performing an extensive exam for a simple problem, the client should kindly ask how it will add to the diagnosis. Of course, a thorough exam may be needed if the problem is not straightforward.

Order only the necessary lab work

Extensive lab work is where costs can really start to add up. As a doctor, with the advent of electronic health records, it is easy to click boxes to order lab work without thinking about why a test is being ordered.

To that point, many doctors forget the cardinal rule we all learned in medical school: "Don't order lab work unless it will change what you do with treatment."

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I recently went to the doctor for a simple physical. My cholesterol had been checked about two years previously, and the result were predictable. My lifestyle or weight hasn't changed in the past two years, and being a healthy female with no history of heart disease or cholesterol problems, I didn't need my cholesterol checked again. All I needed was two simple tests required to undergo anesthesia for the screening colonoscopy recommended at age 50.

Fortunately, I noticed my physician clicking a bunch of boxes on the screen to order lab work; he was checking my cholesterol, liver, thyroid, kidneys and a few other oddball tests.

"All I want is the lab required for my colonoscopy," I said. He replied that he thought I would "want to know" what my other tests showed.

In reality, we both knew that with my good health, the chance that something would show up would be very, very unusual. Why waste the money?

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Unnecessary tests also increase the chance of "false positive" results, meaning something shows up that really isn't a problem. With false positive results, doctors may have to chase down why the lab result is erroneous, adding to costs and anxiety. Basically, lab tests should be used to supplement a history and physical, not replace it.

So, as an empowered patient, how can you help control laboratory costs? Have clients ask this simple question: "How will the result of this test affect my treatment?" If the doctor can't answer that question, the test is probably not needed. The answer "Just so we know" isn't good enough.

"We have left behind the paternalistic days of 'the doctor knows best.' All of us, as patients, have more responsibility for our care."

I suggest that my clients explain to their doctors that tests in question do not fit in their budgets and see what they say. Doctors need to think about controlling costs as well.

To be sure, medical care has changed in many ways. We have left behind the paternalistic days of "the doctor knows best." All of us, as patients, have more responsibility for our care.

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Asserting that responsibility will take time, practice and some fortitude. It will result in better health care at a lower cost to us all.

—By Carolyn McClanahan. special to McClanahan is founder and director of financial planning at Life Planning Partners. A certified financial planner, she began her career as a physician.