A St. Helenan of a certain age was complaining to me recently about age-related hearing loss and the ridiculously high cost of hearing aids. I asked her if she had seen any of the new hi-tech non-prescription hearing devices. She hadn’t.

Many of our consumer shopping choices are being expanded by new technology, from buying shoes to sheets to suits. And medical products are in the game.

“Personal sound amplification products” (PSAPs) right now can only be marketed as hearing boosters for folks with normal hearing. But Consumer Reports found that “some PSAPs, if properly fit and adjusted, can help some people with mild to moderate hearing loss.” A couple of government scientific bodies are asking that the FDA allow these devices to be marketed for hearing loss. And they’re cheap: at most a few hundred dollars as opposed to hearing aids, which can cost thousands.

This has all the characteristics of a classic Washington power struggle: something new and inexpensive up against an entrenched, officially favored industry. The good news is we’re constantly seeing that innovation, while it can be resisted, will eventually triumph. Right now, there is bipartisan legislation before Congress that would loosen the regulation of hearing devices and aids, and increase their availability over the counter.

St. Helena households now have a broad inventory of hi-tech and cheap medical products: glucose monitors, blood pressure machines, even pulse oximeters (to measure blood oxygenation). The burden is on us to educate ourselves on the utility of the data these machines present. That’s not too difficult.

An informed consumer is a wise consumer. Unfortunately, the delivery of medical services is far behind the availability of medical devices when it comes to cost information. This column has for years reported on the frustrations of St. Helenans trying to comprehend medical bills.

One of our bothersome offenders, according to what people tell me, is St. Helena Physical Therapy at Southbridge. The pricing problem highlighted there may apply to all physical therapy offices; St. Helena Physical Therapy is the largest and closest one to us here. I acknowledge that I’m a happy customer of that facility, but then I’m an equally pleased client of socialized medicine. My Medicare (plus supplemental insurance, which I buy) has paid for all my physical therapy bills. Earlier this year, St. Helena Physical Therapy billed Medicare and my insurance $2,410 for five sessions. They received $342.98; I paid nothing. Their inflated invoice – which noone ever pays – is just one example of our screwed-up medical marketplace.

What makes physical therapy unique among many medical services is that it’s not just one office visit; it’s a series of appointments. Folks walk into St. Helena Physical Therapy, set up a bunch of sessions and understandably ask what the cost will be. Invariably, they are told zilch.

They are given the standard statement that it all depends on their particular insurance plan. That’s not helpful, because insurance typically gives us a “explanation of benefits” (EOB) long after the delivery of services. In the usual EOB, the provider’s charge is – finally – listed, plus what the insurance company pays and then what we owe. Depending on policy coverage and deductibles, that final balance can be onerous.

I know of physical therapy customers who, a couple of months after many treatments, have been blindsided by finding out their share of the bill is $1,000 or more. They have no choice but to pay.

Ironically, if you have no insurance, you might get a better deal. I’ve been told of instances where people walk in to physical therapy offices, state they have no insurance and ask for a cash price. And this cash price can be less than the insurance co-payments.

What can and should St. Helena Physical Therapy do to become more customer-friendly? Their available options are straightforward. They could hand out a sheet informing customers what the range of recent customer co-pays per treatment has been. They could tell customers what the cash price is for those without insurance.

I discussed these options with Dr. Steven Herber, CEO of St. Helena Hospital. My experience with him has always been that he is refreshingly honest. He says, “These are things we haven’t thought about.” He says in his own continuing medical practice he offers a 50 percent cash discount for immediate payment; he suggests St. Helena Physical Therapy could do likewise: “We need to offer that courtesy.” His larger point is that “we need to empower” patients. One key bit of information he wants to offer them is to tell them up front the “medical codes” for the services they are receiving. Patients can then talk real numbers with their insurance carriers.

The creative destruction of new technology will eventually infiltrate the delivery of medical services. Just as Amazon will blow to bits outmoded traditions in food stores with its take-over of Whole Foods, that company or others will undoubtedly revolutionize health care economics. Current business models will become obsolete.

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