Do you want your doctor to get paid?

Cracking Open Medical Jargon Case #3: Reimbursement

This is the third in a never ending series of screeds that attempts to crack open words that are misused, misguided misnomers in the healthcare arena. (See Cracking Open Medical Jargon Case #1 Patient Engagement, #2 Patient Portal, #4 Provider, #5 EOB - Explanation of Benefits)

Ok, here is one so ripe for being cracked open, I’m licking my chops.

"Prepare to Die", said Inigo Montoya to the six fingered man.

Reimbursement, prepare to die.

Doctors get reimbursed? Interesting….

Do Lawyers get reimbursed? Do accountants get reimbursed? When you send your check to pay for your Aetna premiums, are you reimbursing them?

The last time I checked, the act of being reimbursed implies that a person gave money and awaiting for someone to give them the money back.

Let’s take a quick look at Webster's Dictionary.

reimburse |?rē-im?b?rs|

verb [ with obj. ]

repay (a person who has spent or lost money): the investors should be reimbursed for their losses.

? repay (a sum of money that has been spent or lost): they spend thousands of dollars that are not reimbursed by insurance.

#wtf

How did it come to pass that doctors don’t get paid, but reimbursed?

Straight out of the Princess Bride when Inigo Montoyo says to Vizzini, “You keep using that word!, I don’t think it means what you think it means”. (watch video for effect)

When did getting paid turn into getting reimbursed? Oh, right. It doesn’t. We need to stop using this word in healthcare. I can assure you, this linguistic gymnastic was not conceived and promulgated by physicians...can you guess who?

Let's see, who in healthcare would like to create words that change the way we perceive how money flows...hmmmmmm

Health insurance used to reimburse the patient after they PAID the doctor or hospital.

I am convinced this is not an epiphenomena of the principal agent problem, but rather a quasi pre-meditated effort to make society uncertain about how money flows from your pocket to payor coffers. For those of you who are not familiar with the principal agent problem, it is a well known economic term that means: when one doesn't pay for the good or service they're getting. (see diagram)

I am not just cracking it open but am exposing it as a mechanism to obfuscate the simple principal and process: I work and I get paid for that work. I buy something and I pay for that something.

It's crazy that someone hasn't spoken up earlier. We are far down the rabbit hole of making reimbursement a fixture in national and local healthcare dialogues and it needs to stop. Now!

Repeat after me:

I will use payment from now on, and never use the word reimbursement again….and if I do, I don't think it means what I think it means.

I will use payment from now on, and never use the word reimbursement again….and if I do, I’m a knucklehead.

We need to cleave this toxic rope in healthcare's Gordian knot

that has polluted our medical nomenclature once and for all – this is one of the most insidious, evil of the words in my series.

Please don't use it anymore. Please.

For the love of Inigo Montoya, clarity and our healthcare system:

"Please stop saying that word!"

(small qualification is that some places actually do buy vaccines, medicines and equipment for resale and then do actually get reimbursed for the money they spent, however, this is a micro-fraction of the $2,600,000,000 dollars spent in healthcare ~ yes, that's $2.6 trillion)

Dr. Shlain is a practicing primary care doctor and founder of Healthloop. Follow on Twitter @drshlain for healthcare and medical issues, broad and narrow..with pith and mirth.