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Mike Cote's Business Editor's Notebook: Taking control of health care starts with the patient

October 22. 2017 12:22AM
Nick Vailas, CEO and founder of the Bedford Ambulatory Surgical Center, thinks small businesses in New Hampshire should band together and create a low-cost provider network. (David Lane/Union Leader file photo)

My wife and I recently racked up more than 40,000 points on an airline credit card, enough to cover another trip to visit our new grandson. We can thank a nasty bout of sciatica for that, and my failure to shop around for physical therapy.

More than ever, we're all responsible for our health care and are expected to become better consumers. Many companies, including mine, offer financial incentives for employees to find low-cost providers.

After the medication my doctor prescribed didn't end the symptoms and relieve the pain I was experiencing - the kind that leaves you writhing on the floor in the middle of the night - I opted for physical therapy and visited a treatment center within my physician's network. My therapist delivered great care and guidance over several visits and gave me a copy of an exercise regimen I can maintain on my own to avoid further flare-ups.

But I could never get a straight answer from the front desk on precisely what each session would cost, and had to wait a month for the first bill to show up. That's just way the system is set up.

By the time I got the bill, I was more than halfway through the sessions so I opted to stay with the same provider. I made arrangements to pay monthly installments so I wouldn't drain our health savings account.

After a couple of months making payments, I received an offer from the provider: If I paid off the bill in full within 30 days, I could receive a 35 percent discount. That deal shaved my bill by nearly $400. The resulting payment was still large enough, however, to cover more than half the required purchases my wife and I needed to make on the credit card to collect those travel points.

If the care had been priced at 35 percent less in the first place, I could have paid it all off at once. Welcome to health care in the 21st century.

Changing the system

I was thinking about that episode a few weeks back as I listened to Nick Vailas make a passionate plea about changing the health care system. The 50 people in a meeting room at the Puritan Backroom Restaurant included small-business owners, health care providers and insurance industry professionals.

They were invited by Member Medical, a health care membership program Vailas founded last year that offers users unlimited access to urgent care for a monthly fee at ExpressMED clinics in Manchester and Salem.

Vailas is best known for being the CEO and founder of Bedford Ambulatory Surgical Center, an outpatient treatment center. He's spent his career bumping up against a hospital-driven health care system, working on ways to offer services that cost less than those providers typically charge.

"There is tremendous capacity outside the wall of a hospital today that for the past 20 years some entrepreneurs have developed, including myself," Vailas said.

His assessment of the health care system was bleak: "I think we can all agree that the health care system is dysfunctional and pretty much broken and usually expensive."

Vailas thinks small businesses in New Hampshire should band together and create a low-cost provider network.

"We need to organize as businesses and purchase in a group way our health care premium and become self-insured. There are taxes you avoid just by becoming self-insured off the top, anywhere from 6 to 8 percent to the better when it comes to self-insuring," Vailas said. "Allow us to create a system that is referred to as reference-based pricing ... where providers get paid for the value of the service, not on a fee schedule."

Such a plan could require legislative action.

State Sen. Andy Sanborn, R-Bedford, noted that state law allows only five entities in New Hampshire, such as bankers and auto dealers, to form associations.

"The most underinsured people in the state are in the hospitality industry - 45,000 people - yet the state of new Hampshire, the politicians, won't allow like industries to associate," Sanborn told the group.

"Number two, we need cost transparency, one bill that everyone can read ... that allows every single person when they come out of their medical care to get a very simple bill that tells them how much money it costs."

Dr. Eric Kropp said he left a hospital system six years ago to found a private practice in Concord. Patients pay a monthly fee for his services. Now he has more time to spend with them, and he can keep costs low by better directing their care, he said.

"When you look at countries that are very successful it's a very high rate of utilization of primary care and low rate of the utilization of specialists. It's the opposite of what we have in this country," Kropp said. "When your employees or patients go to the emergency room or urgent care for some situation, very often that's a portal to more expense sides of care. A strained wrist might be a follow-up with orthopedics, where if I saw it in the office they would follow up with me."

Greater transparency and a system that champions the free market is the path to improving health care, Kropp told the group. But personal responsibility is the primary driver.

"The only way we're going to change health care in this country is by starting with the individual," he said. "That's every one of us and the choices we make."

Contact Business Editor Mike Cote at 206-7724 or

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