Healthcare Prices: Looking Behind the Curtain

Costs of Care Essay Contest!

2010-09-09T19:32:00.000-07:00

Dr. Neel Shah, founder of the non-profit organization Cost of Care recently announced an essay contest with a $1000 prizes.

I encourage patients and clinicians to enter the essay contest. By sharing your stories, you will help other patients navigate the system.

The national essay contest offers $1000 prizes for the best anecdotes from patients and clinicians illustrating the importance of cost-awareness in medical decision-making.

Judges for the contest include:
Gov. Michael Dukakis, former Democratic nominee for President of the United States
Tim Johnson, Chief Medical Correspondent of ABC News
Atul Gawande, surgeon and New Yorker staff writer
Jeffrey Flier, Dean of Harvard Medical School
Gov. Michael Leavitt, former United States Secretary of Health and Human services

Entries must be no longer than 750 words, and should be typed and double-spaced. Students strongly encouraged to submit an anecdote. E-mail submissions to contest@costsofcare.org are preferred, however entries may also be mailed to

Costs of Care
21 Father Gilday Street, Suite 115
Boston, MA 02118

Deadline: November 1st, 2010

Additional submission information available here.

Angies List Partnership

2010-09-09T19:23:00.000-07:00

Healthcare Blue Book is pleased to announce our partnership with Angie's List.

Angie's List has a lot of great health information in their health section.

Our full press release is below:

Angie’s List and Healthcare Blue Book Partner
to Help Consumers Save Money on Doctor Bills

After months of cracking open the secret that consumers can negotiate their medical bills, Angie’s List and Healthcare Blue Book today launched a service designed to help patients shop around for the best price before they even agree to treatment and incur those bills.

“So many of us overpay for health care for two reasons: medical billing is too complicated to figure out and we’re so used to not having any control over price, that we don’t even ask about it,” said Angie Hicks, founder of Angie’s List, the nation’s premier provider of consumer reviews on local doctors, dentists and service companies. “But you can save hundreds, if not thousands, of dollars with just a little bit of effort and still get high quality care.”

A majority of the Angie’s List members (85 percent) responding to a nationwide online poll in July said health care providers should publish their prices, and 61 percent would happily shop around if only they knew the prices area providers charged. Only 25 percent of respondents said they ask about pricing before agreeing to treatment.

“The Healthcare Blue Book takes the mystery out of health care pricing,” said Dr. Jeffrey Rice, founder of the Healthcare Blue Book. “To get fair prices, patients must look up the accepted, average local prices and then make sure their provider agrees to that price before they get care.”

Consumers can sometimes successfully negotiate prices down once they’ve been billed. But Rice cautions, “It is often too late to get a fair price if you try to negotiate after you already received the care at an overpriced provider.”

Starting today on Angieslist.com, members can access Healthcare Blue Book’s local pricing information on visits ranging from ordinary pediatrician visits to complicated surgeries. Blue Book will also walk consumers through the negotiation process, and explain exactly what is required to get a fair price.

While the new tool is simple, Hicks and Rice said consumers may have a difficult time adjusting to this new way of looking at health care. Many consumers are savvy about price shopping for big ticket items like houses and cars, and smaller items like household products, but medical pricing has not traditionally been considered something to haggle over.

That will change, Hicks and Rice predict, once consumers realize, how big the price discrepancies can be. For example:

• In Washington, D.C., prices for an MRI of a right knee without contrast at five imaging centers ranged from $400 to $1504. The Healthcare Blue Book fair price: $912.
• An MRI of the abdomen at three Atlanta imaging labs with and without contrast ranged from $1,190 to $2,543, if payment was cash. The Healthcare Blue Book fair price: $836.
• Cost for an MRI of the lumbar spine with contrast ranged from $500 to $2,661 among eight Chicago hospitals and imaging centers. The Healthcare Blue Book fair price: $522.

In a May 2010 nationwide member poll, Angie’s List found that 57 percent of respondents have never negotiated a medical bill. Nearly 25 percent of them didn’t even know they had that option.

Hicks and Rice cautioned consumers from putting too much emphasis on price when it comes to medical care. Finding health care providers who meet your specific needs and have all the necessary licensing and training is paramount. With the Angie’s List and Healthcare Blue Book partnership, all that information is easily available in one location.

Patients with insurance should make sure they find in-network providers that charge fair rates. Patients without insurance are likely to be charged the highest fees. They particularly need to ask about prices and get agreement up front, Rice and Hicks said.

Angie’s List and Healthcare Blue Book’s Tips on Negotiating Your Medical Bill:

1. Know what you’re up against: Before you agree to a course of treatment, research what you need done, get information on the provider you’ve chosen and the local rate for that service on Healthcare Blue Book, so you know if the rates your doctor suggests are in line with them.

2. Ask for a discount. Cash (or immediate payment) is king in a medical facility, just as is it is with retailers and service companies. Ask if there’s a discount for upfront payment or a no-interest payment plan. Be sure to follow all applicable health insurance rules.

3. Get quotes in writing: If you are price shopping before you have a procedure done, get a signature, name and title to go along with the price quoted.

4. Cover every doctor in the room and the cost of the facility where treatment is given: When getting prices, be sure you cover all fees associated with your procedure, rather than just the surgical costs. (i.e. anesthesiologist, radiologist, facility fee, laboratory costs, etc.)

5. Be polite: Don’t be overly aggressive in seeking a discount. If you cannot afford what you need done, tell your provider. Some medical practices will alert you to payment options, but some may not be actively promoting them. Start with the office clerk you’d normally check out with, but don’t be afraid to ask for a billing manager if you don’t feel like you’re getting a full answer.

6. Review all the paperwork: If a bill seems out of line, ask about it. Check around to determine if the bill is in line with what other facilities charge. Call the billing department armed with your information and ask for the lower charge.

7. Call in expert help: Medical billing is so complex that it’s spawned a new industry of professional bill reviewers, sometimes called medical billing advocates. These specialists are trained to look for incorrect billing codes and duplicate charges. Check credentials before you hire, though. Experts say advocates average recovery of 17 to 49 percent and charge an average contingency fee of about 30 percent. Some charge flat fees, as well.

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1,237 Angie’s List members responded to the May online poll. 1,015 Angie’s List members responded to the July online poll.
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Angie’s List collects consumer reviews on local contractors and doctors in more than 500 service categories. Currently, more than 1 million consumers across the U.S. rely on Angie’s List to help them make the best hiring decisions. Members get unlimited access to local ratings via Internet or phone, exclusive discounts, the Angie’s List magazine and help from the Angie’s List complaint resolution service. Take a quick tour of Angie’s List and view the latest Angie’s List news.

Healthcarebluebook.com, headquartered in Nashville, TN, is a healthcare pricing tool that helps consumers and companies determine what fair prices are for healthcare services and treatments in their markets. The www.healthcarebluebook.com web site can be customized to employers’ needs by offering information that allows employees to identify lower cost and high quality providers within their existing employer-sponsored health plan.

Doctors and Transparency

2010-08-01T14:10:00.000-07:00

Anna Mathews wrote a nice article in the WSJ recently.

The article states that several organizations including the American Medical Association are criticizing the growing efforts by health plans to steer patients toward certain physicians based on cost or quality. The groups sent their arguments in a letter to insurers stating that the rankings may be unreliable and unfair. "There are serious flaws in health insurers' programs to try to rate individual physicians," said Cecil Wilson, president of the AMA.

Well, no doubt rating systems aren't perfect. They probably never will be.

But where are the AMA rating tools and transparency tools? Are there any physician organization leading the effort to improve quality ratings and make costs fair and transparent?

Patients want information on cost and quality. They will use the best information they can find.

If the AMA doesn't like the available rating tools, then they should take a leadership role in developing better ones.

The Healthcare Blue Book has helped thousands of patients find fair prices for care. It will be great to add the AMA's quality and cost information when they decide to share it.

Another TV spot

2010-08-01T14:06:00.000-07:00

Healthcare Blue Book was recently recommened on the Today Show.

Check out the video here.

Here is a link to an LA times article we participated in as well.

We appreciate those who are helping to spread the word to patients.

If patients will review prices before they seek care, they are likely to improve the quality of their care and save $1000's too.

Healthcare Blue Book in the News

2010-07-25T18:17:00.000-07:00

Healthcare Blue Book was included in 2 recent TV shows.

We did an interview for a story by Susan Koeppen on The Early Show on CBS News. You can see the full story and interview with Dr. Jeffrey Rice on the link above.

NBC 12 in Virginia also did a feature news cast on Healthcare Blue Book. You can see the interview with Aimee Stern and story here.

Soceity of Acutuaries Support Pricing Transparency

2010-07-18T13:08:00.000-07:00

The Society of Actuaries released a study supporting the need for pricing and quality transparency in health care.

In a recent release, Actuaries Believe More Transparency in the U.S. Healthcare System Would Help Bend the Cost Curve Downward, they report that creating more transparency between doctors and patients, and the provider community and patients, will be an effective approach at bending the cost curve downward. For example, 86 percent of the surveyed healthcare actuaries recommend making prices for treatments more visible and available for patients. Seventy-nine percent recommend educating consumers and providers on the efficacy of care.

In a separate survey they conducted of consumers, they found that two-thirds of those surveyed support the actuaries' recommendations on the benefits of transparency. Specifically, thirty-seven percent of consumers feel they could better control their own healthcare costs if healthcare providers – or their insurance company – told them about the costs of medical services and the quality of the outcome of procedures. And thirty percent feel they could better control their healthcare costs if, before administering a medical procedure, their physician informed them about the costs of the procedure, the number of times he/she has performed the procedure, and its results.

Healthcare Blue Book is working with provider groups, employers and insurance companies to promote pricing and quality transparency. Employers see transparency as one of the best ways to improve quality and lower costs.

Federal Legislation for Pricing Transparency?

2010-05-13T14:05:00.000-07:00

The House has 3 bills under consideration for promoting health care pricing transparency. Unfortunately, there is no commitment for moving the legislation through this year. And no bills introduced in the Senate yet.

The worst indication of where this may be heading came from Frank Pallone, chairman of the Energy and Commerce health subcommittee. “The concern I guess is about the unintended consequences of too much transparency,” he said. Apparently he believes such transparency will make prices go higher since Peter Orszag stated so back in 2008. If we assume that future health benefits will preserve the worst parts of the insurance models, then maybe that is possible.

However, if we look at private reform and adopt the newer benefit designs with consumerism, then we are much more likely to see prices fall as consumers engage in their care decisions.

Until the legislature brings meaningful pricing disclosure requirements, consumers can find fair price estimates for free at Healthcare Blue Book.

The three bill were summarized by California HealthLine

Bill Details

HR 4700: The bill -- sponsored by Rep. Steve Kagan (D-Wis.) without any Republican support -- would require hospitals, physicians, nurses, pharmacies, and a number of manufacturers and vendors to disclose publicly the prices they would charge patients. The HHS secretary would levy a fine on providers and vendors that fail to comply with the requirement (Ethridge, CQ Today, 5/6).

HR 2249: Cosponsored by Texas Reps. Gene Green (D) and Michael Burgess (R), the bill calls for transparency in hospital charges (Pecquet, "Blog Briefing Room," The Hill, 5/6). The legislation also would expand reporting requirements to all 50 states and require insurance companies to disclose out-of-pocket cost estimates for a number of medical procedures (Reichard, CQ HealthBeat, 5/6).

HR 4803: The proposal, sponsored by House Energy and Commerce Committee ranking member Rep. Joe Barton (R-Texas) with broad Democratic support, would cover ambulatory surgical centers serving patients who are not hospitalized after their operation ("Blog Briefing Room," The Hill, 5/6). It would require the centers, as well as hospitals and private and public health insurers, to disclose to their patients and customers information about the costs for services they provide and the items and services that they cover, respectively (CQ Today, 5/6).

See also comments at:
The Hill

Wisconsin Legislation for Price Transparency

2010-05-02T09:23:00.000-07:00

In the fall of 2009 there were a lot of articles on 'facility fees' that are added to doctor's bills for office visits when the doctor works for a hospital.

Wisconsin is now considering requiring pricing transparency for the extra fees. Proposed legislation (AB 207) would require clinics that charge "facility fees" - meant to cover extra costs incurred by hospital-owned facilities - to tell people about them at the time they make appointments and to provide an estimate of what they will be.

Wisconsin has already passed one law to encourage pricing transparency, thought the law does not take effect until 2011. Wisconsin Act 146 requires hospitals and other health care providers to give patients a list of common procedures and what the provider charges for them, as well as what Medicare and insurers typically pay for them. This will provide some very useful information for patients.

In addition, Wisconsin is considering a law that would would require health care providers to give patients an estimate of the cost of any procedure, test or other service if it is expected to be more than $500. It would also require more disclosure to patients by insurance companies of the coverage amounts for certain medical services and estimates of out-of-pocket costs and costs for services from out-of-network providers. (Assembly Bill 539)

Alfie Tackles Health Literacy

2010-04-30T07:58:00.000-07:00

Jeff Knott is a strong champion of health literacy. Based on his personal experiences with the health care system, he is committed to helping others understand the system and advocate for themselves to receive quality care.

He combines comedy with education to provide a fun learning experience for patients.

Watch for Alfie. You can see the educational videos on youtube.

Here are a few of them.

Dirty Magazines

Nurse Practitioners

Staph Infections

AHIP Calls for Transparency

2010-04-02T18:01:00.000-07:00

The consequence of health reform continue to unfold.

One interesting development is the response by health plans to the HHS request for transparency of price increases.

AHIP wrote a letter to HHS suggesting that health plans would be glad to provide transparency into rate increases, and would like the same standard to be applied to providers.

The letter reads in part:
"As you request transparency from our members, we urge you also to consider pursuing transparency for hospitals, physicians, pharmaceutical and device companies, and other suppliers. Consumers should have data on year-to-year price increases in these sectors, as well as quality performance information. We believe this is an opportunity to ask of all other sectors what you are asking of health plans. Pursuing transparency in these sectors is essential both to educate consumers about what drives health care costs and to ensure that patients and their doctors have the information and decision support tools they need to make informed decisions in accessing care and in choosing among providers and care options."

Asking health care providers to explain price increases implies that consumers know what prices are to begin with.

What an excellent idea.

The Healthcare Blue Book welcomes the idea that HHS will encourage all providers to provide real pricing transparency to consumers.

Walgreens Pulls Out of Mediciad Program

2010-03-29T15:51:00.000-07:00

Walgreens announced that it was pulling out of Washington state's Medicaid program because the state was paying prices that did not cover the actual cost of many of the program's medications.

For many years the government programs (Medicare and Medicaid) have paid lower prices than other payers. They are able to do this because of the hidden subsidies that other payers pay to make up for short falls in government program payments.

With health reform upon us, we will need to closely watch these trends. Part of the reform package brings Medicaid payments up to Medicare levels. But will this create even more pressure to further lower Medicare rates?

On top of the hidden subsidies, the private payers will now pay a premium tax too.

Does this ultimately push the private insurers out of business and leave us with a single payer option? Or does the government v. private pay differential grow enough that we end up at a two tiered system?

Time will tell, but as providers refuse to deal with certain payers, politicians and the markets will react.

We welcome the provider feedback (Walgreens as an example) that incentives can change provider behavior. If politicians and the markets would incorporate more consumer incentives, then maybe we will end up with a value based system that patients will embrace.

Health Reform and Consumerism

2010-03-21T13:49:00.000-07:00

Regardless of your position on the current health reform, it will soon impact consumerism movements that have been shaping the healthcare landscape and helping to hold prices down.

Consumerism provides individual patients with some economic responsibility as they make decisions regarding their healthcare; hoping to strike a balance between making care affordable but also making sure those paying for care are getting value for the resource they spend.

The reform legislation will probably change over time, but as of today, based on the Senate's bill; here are some of the impacts on consumerism:

Promoting consumerism:

Linking payments to hospitals to providers based upon quality of care instead of volume of services (2012).

Linking payments to physicians to providers based upon quality of care instead of volume of services (2013).

Taxing high cost insurance plans (2013).

Increasing the threshold for claiming itemized deductions for medical expenses (2013).

Limiting Consumerism:

Eliminating Lifetime Limits and Restricting Use of Annual Limits (2010).

Covering Preventive Health Services at 100% (2010).

Reducing the Part D “Donut Hole” or Coverage Gap (2010).

Limiting Health Flexible Savings Account Contributions (2011).

Eliminating Annual Limits on health insurance coverage (2014).

It will be interesting to see how the final legislation changes over time and what its ultimate impact will be on consumerism.

Based upon patient usage of the Healthcare Blue Book, we know that many patients are very capable of finding high quality care at reasonable prices when they have an incentive to do so.

Save Big

2010-03-11T11:28:00.000-08:00

Elisabeth Leamy who is the Consumer Correspondent for the Good Morning America show has a new book out called Save Big.

In addition to tips on expenses around housing, transportation, loans and grocery shopping, she has an entire section devoted to healthcare costs.

It is definitely worth reading and can help consumers with health insurance suggestions as well as suggestions for finding care and prescriptions.

Not surprisingly she recommends negotiating with your doctor.

We were glad to see that she suggested using The Healthcare Blue Book as a great place to find out how much your care should cost. As Leamy reports, the Healthcare Blue Book's fair price is "a great starting point for discussion- and negotiation."

Why do we pay more money without getting better quality care?

2010-02-28T15:15:00.000-08:00

Value is one of the most important missing topics in the health reform debate.

We might not be so concerned with how much health care costs or how much of our national budget gets devoted to health care, IF we felt we were getting good value for our money. But the fact is that we all know we aren't getting a good value. We see prices continue to rise faster than inflation and very often that is accompanied with lower levels of service, less time with our doctors, etc.

There have been some studies focused squarely on this issue. I have commented before on the Health Affairs article last year.

Now comes a nice report from Massachusetts that examined the costs of healthcare and how they relate to quality.

What did they find?

Their preliminary review revealed serious system-wide failings in the commercial health care marketplace which, if unaddressed, imperil access to affordable, quality health care.

Their investigation has shown:

- Prices paid by health insurance companies to hospitals and physician groups vary significantly within the same geographic area and amongst providers offering similar levels of service.

- Price variations are not correlated to (1) quality of care, (2) the sickness or
complexity of the population being served, (3) the extent to which a provider is
responsible for caring for a large portion of patients on Medicare or Medicaid, or (4) whether a provider is an academic teaching or research facility. Moreover, (5) price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities.

At The Healthcare Blue Book our work with employers reveals this fact frequently. We routinely see employees paying 500% more than necessary for common services while getting no better (and sometimes lower) quality of care. These are prices paid to in-network providers; and prices that ultimately are paid for by the employer under their health benefit costs.

The more research the better, but each study points in the same direction: there is a lot of opportunity for employers and employees to lower costs and raise quality.

If Air Travel Worked Like Health Care

2010-02-20T04:38:00.000-08:00

People are always comparing the health care system to other industries.... Well now you can watch the movie.

Check out this video, you may not know whether to laugh or cry.

Of course they highlight the issues of transparency and the challenges faced by consumers in having to work with multiple providers to get a single service.

The Healthcare Blue Book is working to solve both of these problems. Maybe if all the CEOs working in the healthcare system would watch this video, they could find a little motivation to cooperate in solving these issues.

How Much Will Your Surgery Cost? Hospitals Can’t Tell You

2010-02-04T07:28:00.000-08:00

Press Release regarding Healthcare Blue Book Survey: How Much Will Your Surgery Cost? Hospitals Can’t Tell You

Washington, DC. -- Patients are the losers in both the Democrat and Republican versions of the health care reform bills. Proposed health care reform won’t help patients find out how much health care costs before they get care and many hospitals aren’t set up to help.

A new research paper from The Healthcare Blue Book (www.healthcarebluebook.com) entitled Surgery Pricing Secrets: The Challenges Patients Face, shows that it is almost impossible to get prices ahead of time if a patient plans to have surgery in a hospital.

Healthcare Blue Book researchers found that:

• It took three times as many phone calls and four times as long to get pricing information from a hospital.

• Hospitals would not provide guaranteed prices and price ranges often varied by more than 100%.

• ASCs were more likely to discount prices for cash customers; regardless of the patient’s financial status.

• Facility fees are 3-4 times higher in a hospital than in an ASC.

Healthcare Blue Book researchers contacted hospitals and ambulatory care centers (ASCs) in three markets: Raleigh-Durham, NC; Denver, CO; and Portland, OR. Hospitals and ASCs were asked to provide the costs of an anterior cruciate ligament surgery of the knee for a patient without health insurance.

Queries were primarily about facility fees, but researchers also asked respondents about other fees associated with the surgery.

It’s almost certain health care expenditures, which totaled about $2.5 trillion in 2009, will continue to climb by at least 6% a year. Hospital costs are 31% of the total according to the Centers for Medicare and Medicaid Services. So what are health care consumers going to do?

The Healthcare Blue Book, an Internet content provider, offers a free consumer guide to fair pricing for healthcare treatments and services for local markets at www.healthcarebluebook.com.

“One of the main tenets of successful healthcare reform will be patients taking more responsibility for finding out what their care costs as they make treatment decisions,” said Dr. Jeffrey Rice, Healthcare Blue Book CEO, and white paper author. “But until hospitals are able to provide exact pricing, managing out of pocket costs for both insured and self-pay patients is almost impossible.”

For a free copy Surgery Pricing Secrets: The Challenges Patients Face go here.

Cut Your Health Care Costs Now!

2010-01-31T09:26:00.000-08:00

Cut Your Health Care Costs Now! is a new book by Brandi Funk, FNP-C that I just had the opportunity to review.

Brandi Funk is a board certified family nurse practitioner and health care advocate. With 15 years of experience helping patients, she as a lot to offer in her book.

Her book begins with suggestions for buying health insurance. Most importantly are the check lists to make sure your coverage will actually cover you.

She next shares useful tips on using your insurance. The book has lots of tips for traditional insurance and also for using Medicare. While many readers may have traditional insurance, they may also be helping their parents with issues involving Medicare.

Healthcare Blue Book is focused on helping patients get quality care at affordable prices. Cut Your Health Care Costs Now! offers many suggestions to patients on how to save on health care expenses and prescription drugs. Of course, one of my favorite tips in the book is "Negotiate Your Price First". As we see every day, once a patient gets care; it is very difficult to lower the final bill. However, patients can save $100's or even $1000's if they know to ask about prices first. Often they improve the quality of their care too.

Cut Your Health Care Costs Now! has many other tips for consumers. It is well worth your time and I imagine that most consumers will save a lot more than the book costs. A book that pays for itself, how can you beat that?

The book is provided as an e-book. One neat thing about the e-book format is the fact that you can directly link to valuable resources provided in the book. Ms. Funk has excellent reference sources, lists, and content links throughout the book.

You can find the book here.

The People's Health Care Reform Plan

2010-01-25T13:35:00.000-08:00

I just received an article by Dr. Bradley Hennenfent: The People's Health care Reform Plan.

The Plan starts off like this:

+++++++++++

Let's be part of the Health Care Reform solution. Let's distribute a plan that empowers patients, doctors, and nurses, which everyone can understand. The People's Health Care Reform Plan will make PATIENTS MORE POWERFUL, and the Government, corporations, and insurance companies (crony capitalism) less powerful. This plan will reduce costs, increase access, and save the most lives. It's also simple.

SHORT VERSION OF THE PEOPLE'S HEALTH CARE REFORM PLAN

1. Tell us patients what everything costs - no more secrets.
2. Give doctors, nurses, and allied health care professionals social networking so they can tell us everything they know.
3. Tort Reform.
4. Distribute The People's Health Care Reform Plan to everyone in America and around the World via Facebook, E-mail, etc.

PATIENTS GETTING CONTROL OF PRICES

Congress must facilitate that patients be told the price of everything in health care in advance, except in true emergencies, or they do not have to pay.

Patients cannot spend money from Medicare, Medicaid, Insurance Companies, Unions, or their own money, wisely if they do not know what anything costs. It's these hidden prices that cause monopolies that drive up our prices and result in unsavory backroom political deals. It's not knowing the price of anything that enables Medicare, Medicaid, and corporate fraud to occur so easily. How can we know if we are overcharged if we never know what anything costs in the first place? How can we revolutionize health care if we don't know what costs too much? We need to know the prices.

+++++++++++

The plan goes on to include aspects of getting more information to patients via technology and clinician input; tort reform; putting more power with patients and direct care providers; and finally a plan to get the plan out.

You can read the entire plan at Dr. Hennenfent's FaceBook.

It is easy to support pricing transparency and some of the other concepts in the plan. Healthcare Blue Book provides nice technology that helps patients with comparison pricing.

So what do you think about the Dr. Hennenfent's plan?

The bigger question to me, is why is it left to individuals to promote common sense solutions that would actually help reform the health system?

Marathon Health and Healthcarebluebook.com Join Forces to Help Employers Reduce Healthcare Costs

2010-01-12T14:41:00.000-08:00

NASHVILLE, Tenn.--Marathon Health and Healthcarebluebook.com today announced a co-marketing agreement to bring new consumer education and healthcare price transparency tools to employers with consumer directed health plans (CDHP) or high deductible health plans (HDHP).

The joint offering extends Marathon Health’s onsite clinic capabilities by helping employees with significant out of pocket expenses make informed, cost conscious decisions on treatment. Both onsite clinicians and employees will have access to the Healthcare Blue Book’s education and healthcare price transparency tool. Marathon Health clinic patients can access the Blue Book tool directly from the Marathon eHealth Portal, or work with their onsite clinician to consider treatment options, understand out of pocket costs, and make smarter, more affordable treatment choices when seeking care outside the clinic setting.

“Price shopping for healthcare services can be time consuming and frustrating,” said Marathon Health CEO Jerry Ford. “Our co-marketing agreement with Healthcare Blue Book will help us provide a virtual ‘safety net’ for the employees with high deductible plans who require greater access to cost and care details. This addition to our technology platform will ensure our patients have the information they need when making care decisions.”

The relationship enhances Marathon Health’s value proposition for employers who offer CDHPs by bringing timely consumer decision support to the point of care. The joint offering fills a recognized gap in employers’ consumer tool set, and helps both employee and employer save money through better use of their existing provider options.

“Marathon Health and Healthcarebluebook.com are innovative companies creating new models for delivering high-quality healthcare at a fair price,” said Healthcarebluebook.com CEO, Dr. Jeffrey Rice. “Joining forces will help us create systems that can benefit employers and employees through improved access to high-quality, cost-effective care.”

About Marathon Health
Marathon Health of Colchester, VT, offers a proven solution for helping employers reduce the total cost of healthcare. The Marathon Health approach integrates the best practices of onsite primary care, health assessment with risk identification, coaching and advocacy, and disease management for high cost chronic conditions. Marathon Health supports its unique model with an eHealth Portal delivering medical content, interactive diet and fitness tools, a personal health record, and an electronic medical record to manage care. www.marathon-health.com.

About the Healthcare Blue Book
Healthcarebluebook.com, headquartered in Nashville, TN, is a healthcare pricing tool that helps consumers and companies determine what fair prices are for healthcare services and treatments in their markets. The www.healthcarebluebook.com web site can be customized to employer needs by offering information that allows employees to identify lower cost and high quality providers within their existing employer-sponsored health plan.

NJ Hospital Charges Top the Charts

2009-12-17T12:50:00.000-08:00

A recent article by Susan Livio highlights the billing practices of NJ hospitals. Such practices have them billing a lot more than many other hospitals in other states.

National health care economist Graham Atkinson said concerns are well-founded. New Jersey hospital charges are 4.1 times higher than what it costs to treat patients — far exceeding the national average of 2.8 times above cost, he said, based on American Hospital Association data.

A report put out by the New Jersey Health Care Quality Institute shows the impact of the high prices and the state's policy on billing.

While state laws insulate some patients from the impact of hospitals' full charges, many patients are still paying way too much. For example, if a single patient makes $32,000/year and receives an appendectomy at Elmer Hospital, he would pay just $4,797. However if that same patient happened to make $52,150/year the price would jump to over $43,000. So if one patient makes $20,000 more than another one, then they would pay over $38,000 more for their care (or 9 times more).

By comparison the Healthcare Blue Book has a fair price for the procedure of approximately $12,000.

Given the high prices charged by many NJ hospitals, patients need to be particularly careful when seeking hospital care.

Everything Old Is New Again

2009-12-12T13:03:00.000-08:00

Blue Cross Blue Shield of Massachusetts Inc. recently announced a deal covering 60,000 members of the Caritas Christi Health Care system. The new payment arrangement is touted as one of the country's largest experiments in fundamentally changing the way doctors and hospitals are paid.

The contract includes a so-called global payment system in which the hospitals will be paid fixed amounts based on the estimated annual costs of patients’ care instead of the fee-for-service system in which providers bill insurers for individual visits and procedures. It also includes incentives to improve the quality and affordability of care.

Not to take anything away from a health plan attempting to address the ills of fee for service incentives, but the new system has an old name: capitation.

Capitation payment systems have been used in many forms for many years. However capitation has not become the predominant payment system in US healthcare because it shifts the provider incentives from doing too much to potentially doing too little. Providers want to deliver good care and be compensated in a reasonable manner. Asking providers to be the arbiters of the value of treatments puts them in an uncomfortable, if not impossible, position.

Patients should decide the value of treatment options. Different patients will make different decisions.

To actually make a fundamental change the current healthcare system, health plans need to support pricing transparency and plan designs that let patients have some 'skin in the game' as they make decisions.

Related articles:
WSJ
Boston.com

Facility Surcharge for Doctor Visits

2009-11-18T21:46:00.000-08:00

Consumers must always be careful of hidden fees and unexpected charges when purchasing healthcare services. A new version of hidden fees has been gaining attention the past several months: Called "provider-based billing", there is a rule that allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services as long as the bill all patients for it.

What does this mean? If you go to your doctor for an office visit, you expect to pay for the office visit. If you happen to go to a doctor that is owned by a hospital, then you may also be charged a "facility charge". According to Kaiser Health News facility charges can range from $25 to hundreds of dollars. Unaware consumers can be in for quite a surprise.

One of the troubling issues that results is the fact that this hidden billing has its largest impact on uninsured and self-paying patients. While the Medicare program allows hospital owned physicians to charge the facility fee, Medicare typically dictates a below market fee schedule for the physician services. Private insurers can also negotiate set rates that eliminate the facility fees. Self-pay patients are left paying the full amount of the physician bill plus the facility fees.

Given the recent increase in physicians joining hospitals as owned practices, the issue of facility fees is likely to grow.

For other reports on this see:
Cleveland Plain Dealer
USA Today

$100M Healthcare Pricing Database

2009-11-08T10:24:00.000-08:00

We have been following the NY attorney general's cases against Ingenix and large health insurance companies. The attorney general recently announces where the $100M in fines will go and what they intend to do with the healthcare data.

They will create a new Non Profit entity called FAIR Health that will be centered at Syracuse University. Other NY universities will share in the money and collaborate on the project.

FAIR Health will ultimately offer pricing information to consumers on a new website they intend to create. It should help consumers understand typical Insurance company reimbursement for out-of-network care. They hope to have the website up within one year.

You can view the attorney general announcing FAIR Health here.

Public Option To Have Pricing Subsidy

2009-10-21T12:55:00.000-07:00

Back in July we got a preview of the difficult situation of creating a Public Option that "competes fairly" in the market versus the hint that the Public Option might pay doctors below market rates.

Today the Washington Post reports that the House is planning a reconciled bill that "would include a government-run insurance plan that pays providers at rates tied to Medicare." Medicare rates are well below commercial market rates for most healthcare services.

This development is unlikely to promote pricing transparency. Medicare's current payment system sets most physician fees at a similar level which could foster transparency. However, it is very difficult for patients to determine what the specific fees will be before they receive care. This difficulty arises from complicated geographic adjustments and the fact that care levels, and therefore pricing, are generally determined after the care is provided.

In addition, Medicare's rules provide different payments to providers based upon place of service and many other factors. If you have a service performed at one hospital you will likely pay a different rate than if you had used the hospital across town. Have the service performed at an out patient facility and it could be much less expensive.

If consumers don't know what healthcare costs before they get treatment, it is very unlikely they will be able to help get more value for all the dollars they spend. Let's hope that whatever shape the final health reform bill takes that it will at least bring more transparency to the consumer.

FeelingFlu.com

2009-10-07T11:37:00.000-07:00

It is hard to read the paper or watch the news without hearing something about the H1N1 flu (also called swine flu). But what should patients do? how can they understand their symptoms? Should they try to get the vaccine early on?

Now there is a really nice website devoted to helping patients understand swine flu and more importantly what they need to do. The site is found at feelingflu.com.

It is sponsored by A.D.A.M. who has a great reputation for providing consumer health information. This new website has a key feature that allows individuals to take a free online assessment. According to A.D.A.M. the proprietary, interactive tool uses a “self-triage” branching logic system to assess the individual’s symptoms and other information and then provides information about the most appropriate course and timing for treatment.

I encourage you to check out feelingflu.com

Too Much Care?

2009-10-05T17:45:00.000-07:00

In the past couple of weeks health care writers have been warning about the pitfalls of too much care. Maybe they are priming the pump for the potential of healthcare rationing in the future? More likely they are revealing one of the areas that gets little attention but results in a lot of unnecessary expense.

A Washington Post article, In Delivering Care, More Isn't Always Better, Experts Say, explores the unnecessary care delivered each year. According to a 2008 report by New England Healthcare Institute, wasted expenditures total over $700 Billion every year.

The Wall Street Journal also addressed this issue recently: Getting Well: It's About Time. While we don't want patients to avoid necessary care, in many cases patients will get better own their own. For example, Americans spend approximately $1 billion every year on unnecessary antibiotics for viral infections. These antibiotics don't treat the illness and lead to antibiotic resistance.

The savings opportunities are large and they are real. However, it is unlikely we will achieve savings in this area unless we give consumers the incentives and education they need to make value based healthcare decisions.

Will Anyone Know the Price of Their Drugs?

2009-09-25T14:26:00.001-07:00

While the Senate Finance Committee rejected a proposal requiring drug companies to rebate an additional $100 Billion over 10 years, the agreement reached earlier this summer still requires $80 Billion in drug rebates over 10 years.

Rebates are often difficult to track or understand and are not helpful for consumers that want price transparency.

If we are going to ask patients to be make cost conscious decisions about their care, we have to able to let them know how much that care costs. If patients are charged one price at the check out counter, but the government or insurance companies later get rebates on those drugs purchases; then the consumers really never know the true cost of their medications.

Maybe we should stop the rebate game as part of health reform?
An accurate, upfront price would be helpful for consumers.

To read more about the current politics around the rebates, see the NYT.

First Know the Problem, Then Fix It

2009-09-17T14:55:00.000-07:00

This is the recommendation from the dean of Harvard Medical School, Dr. Jeffrey S. Flier. See his article here.

He suggests three problems that are at the root of the healthcare system.
1- A tax system that hides the true cost of employer provided coverage and significantly penalizes individuals.
2- Over regulation that limits innovation in health insurance and health care.
3- Large government programs (Medicare and Medicaid) that have fundamental inefficiencies and inequities in the way they pay for care.

All of these issues also directly impact pricing transparency in healthcare. Employer provided coverage has shielded individuals from the true cost of care and limited their need to understand healthcare pricing. Over regulation has limited competition and provided cover for insurers to hide provider pricing. Government programs underpay providers in many instances causing price shifting and distortion in the consumer market.

Dr. Flier doesn't offer a lot of hope for the current health reform initiatives suggesting that even after six decades, they haven't even fixed some obvious problems with tax deductibles for individuals.

It is hard to argue with the premise that you need know what the problem is before you try to fix it.

I would also suggest that pricing transparency is one of the core problems that needs to be understood and addressed.

Pricing Transparency In Minnesota

2009-08-27T14:54:00.000-07:00

A new website promises to provide pricing transparency to Minnesota residents.

The site can be found at www.mnhealthscores.org and is offered by MN Community Measurement.

It primarily focuses on primary care services covering office visits, minor procedures and surgeries, labs, mental health and obstetrics. Just over 100 providers are listed in the new service.

The site is generally better and more informative that most state's pricing transparency efforts. The information includes specific provider pricing information such as the average price and the range of prices for each provider based upon what they typically charge insured patients.

For a list of other state specific sites see Healthcare Blue Book.

I can recommend that Minnesota consumers use this site, but they must remain aware that the prices provided are not a guarantee of the actual price patients will pay. Consumers must still make sure they request specific pricing prior to receiving services. Consumers can get free tips on how to discuss pricing with their doctors at Healthcare Blue Book.

Americans can agree on many healthcare reforms

2009-08-19T12:30:00.000-07:00

Recently John Mackey wrote a thought provoking editorial in the Wall Street Journal- The Whole Foods Alternative to ObamaCare

While some take issue with his suggestions for health reform, it is nice to hear an alternative to the assumption in Washington that the government can or should solve every problem by increasing the federal government’s involvement in personal and local issues.

Of course we need some health reforms, but the current proposal lacks many opportunities for improvement that the vast majority of the American people would support.

To name three easy ones addressed in Mackey’s article:

Pricing Transparency- What American would argue for a system that allows some patients to be charged 3, 5 or even 10 times more than the next patient for the same service at the same location? Who would support a system that allows hospitals to charge those without any insurance much more than those with insurance? The government doesn’t need to set prices; that would rightly offend many Americans as limiting the markets or freedoms. But there should be broad public support for pricing transparency so that patients will know how much healthcare services will cost and a simple rule that hospitals will charge all patients the same price.

Equal tax treatment for health insurance- What Americans would vote against allowing individuals to deduct their health insurance but allow companies to do so? The vast majority would support equalizing the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

Tort Reform- What American would vote against tort reform? The lawyers, sure. Anyone else? So let’s say 85% support for this one. Are the politicians listening to the people? No, they left this out too.

Since the politicians are leaving out the easy improvements that most voters would support, we have to ask ourselves who are the politicians listening to? If not the voters, then maybe the lobbyist? Big business?

With a 1000+ page bill, they ought to be able to find room for the simple things that most Americans would support.

Keep the dialogue going, maybe at some point the politicians will listen.

The Public Option

2009-07-31T07:33:00.000-07:00

President Obama is championing a "Public Option" to offer insurance to Americans. The government's Public Option is proposed to give Americans more choices and pressure traditional insurance companies to do better. Obama has stated that the Public Option would compete fairly with the private insurers on a "level field".

We all need to evaluate this issue. If the Public Option is subsidized by the government, then it will offer 'cheaper' premiums - even if its costs are really higher. If people can buy a government subsidized Public Option that may cover more with lower premiums, then how will private insurers survive? They won't over time.

So will the Public Option use the government's power to compete on a "level field" with private insurance?

Let's make this simple. One proposal states that the Public Option would pay healthcare providers 105% of Medicare rates. However, a Federal Court in Florida recently ruled that a private insurer must pay 239% of Medicare rates to providers. The Federal Court found that 239% of Medicare rates was fair and a reasonable market rate to pay providers. See Weinberger, et al v. Aetna Health, Inc., No. 1:2006-cv-20249).

So let's stop there. The Public Option will pay less than 50% of a fair market rate.

Is there any way the Public Option can be championed as another market based insurance alternative competing on a level field?

What will happen to private insurance as an option?

Where is the mature, responsible and thoughtful health reform we need?

Obama speaks out on health reform: Do his words match the reality?

2009-07-20T10:46:00.000-07:00

The President just gave a pep talk for health reform but most of the speech was at odds with what is actually being proposed in the 'reform' legislation.

"The healthcare system is breaking families and businesses" but the current reform proposal doesn't include any major reforms that would decrease costs. In fact, the CBO estimates that costs are likely to GO UP under the current proposed reform.

And while our families and business are being financially broken, the current proposal adds taxes on families (only on the 'rich', maybe) and an unfunded mandate on business or an 8% tax on wages. Obviously increasing costs on families and business will not lower their costs. Did i miss something??

The President stated that we "cannot put off the hard work" required to achieve healthcare reform. But this is the biggest contradiction going. Clearly there are reforms that can help the healthcare system and the insurance system. They may even receive bipartisan support and public acceptance. But the current proposal is not the result of 'hard work'; it is a plan to spend money we don't have on a system that doesn't provide good value in the first place.

A proposal that simply spends money we don't have or make others spend money they don't have is immature and irresponsible. It is 'reform' for the headlines; not for the patients.

Absent from the entire conversation and proposal are the details that call for personal responsibility in the healthcare system, whether it is taking care of one's health or spending money wisely on necessary services. Clearly that is where the reform needs to start. The system is too expensive primarily because there is little personal accountability today. It will take a thoughtful, mature, and responsible leader to accomplish this. I hope the President or someone in Congress will step up to the challenge.

Quality and Cost: Do you get what you pay for?

2009-06-23T04:28:00.000-07:00

As we buy many products and services, we expect to get better quality if we are asked to pay a higher price. The new sports car is obviously more expensive and better quality than the used clunker. Of course we probably check consumer reports and other ratings before we buy just to be sure. We know high price doesn't guarantee that something is high quality. In other situations we may pay more just for the brand.

What about healthcare? Does paying more mean you are going to get higher quality?

Health Affairs published a nice study examining this issue. They looked at quality indicators and costs at specific hospitals. The bottom line: they found that many quality indicators did not improve with increasing costs and for others the quality went down at the more expensive hospitals. There were not any examples of higher quality resulting from higher costs. They also did analysis on the "Brand" issue in healthcare by looking specifically at academic medical centers. Increased costs at those centers did not add to quality either.

While the issues are complex and this study only examined a small set of clinical situations; consumers should realize that finding quality care requires careful research. And consumers should not assume that expensive providers or brand name providers have good quality. According to this study, and others, the opposite may be closer to the truth.

For useful links to quality ratings of providers, consumers can check out the Resources for Patients section at the Healthcare Blue Book.

The Health Affairs article at: Health Affairs 28, no. 4 (2009): w566–w572 (published online 21 May 2009)

ACE Pilot for Consumerism and Value Based Purchasing

2009-06-10T15:07:00.000-07:00

A new demonstration project from CMS will provide patients with financial incentives to qualifying Medicare patients who select a health care provider based on quality and price.

As part of the Acute Care Episode (ACE) demonstration, five regional health systems nationwide have been designated Value-Based Care Centers. These centers will provide select cardiac and orthopedic services to Medicare beneficiaries at discounted rates.

CMS will share a portion of their savings with patients.

You can see an article on this at the Oklahoman paper.

This is a very interesting pilot.

It should give encouragement to other privately insured organizations that are exploring similar incentives.

101 Ways To The Best Medical Care

2009-05-31T06:19:00.000-07:00

I just had an opportunity to read an interesting book titled "101 Ways To The Best Medical Care" written by Charlotte E. Thompson, MD.

The subtitle is "The medical guide that could save your life". Since patients don't have transparency in healthcare quality information and there are so many medical quality issues, that statement may be true for some readers. If you have to be admitted to the hospital, have a challenging clinical issue or simply "fall through the cracks"; your life could be at risk. Each patient needs to take an active role in their care to protect their health and safety. Books like this one can give patients some ideas to consider.

The book is very wide ranging; covering topics from clinical issues (doctors, hospitals, emergencies) to Insurance (medicare, overseas) to administrative (medical records, etc.). While not every chapter will apply to each person, it is likely that many chapters will be useful to most patients.

The chapters on finding a different doctor, getting the best care and becoming informed were very useful. The chapter on hospital care was also a gem - warning of teaching hospitals, nursing shortage and what patients should do.

Given the breadth of the book it isn't surprising that I would take a different approach or view on some of the advice. While I agree that using the yellow pages to find a doctor won't give you any useful quality information; I'm not sure asking friends will be much better. Quality information needs to come from qualified and trusted sources. I always recommend checking federal and state websites when available.

And the statement "you usually get what you pay for" on page 8 is definitely not what I have found in my research on healthcare quality and pricing. At best there is no definitive link between cost of care and quality of care; and some evidence draws the opposite conclusion: higher quality care can cost less than poor quality care. See Health Affairs just this Month- Hospital Quality And Intensity Of Spending: Is There An Association?

While I see a few things differently, I congratulate Dr. Thompson on her efforts and her book. It has some great advice that should help many patients.

Healthcare Blue Book In The News

2009-05-19T11:03:00.000-07:00

There is an interesting article in the Tennessean on Nashville based healthcare start ups. See all the articles here.

We were pleased to be included.

Here is part of the story :

Healthcare Blue Book: Making the most of cost comparisons

By Getahn Ward • The Tennessean • May 17, 2009

For years, Kelley Blue Book has been a go-to source for car buyers and sellers who want to gauge the value of vehicles.

Dr. Jeffrey Rice and Bill Kampine hope their Healthcare Blue Book becomes the same type of resource for consumers seeking information on prices of competing health services.

At healthcarebluebook.com, consumers can compare “fair” cash prices that they would expect to pay out-of-pocket for a range of procedures and medical services within their ZIP codes. The company also targets employers with a customized version where employees can see what each provider gets paid and how they rate on quality. The idea is to help patients decide where to seek care.
“It’s to help consumers find the right care from the right provider at the right price,” said Kampine, a co-founder of Healthcare Blue Book.

Companies such as Healthcare Blue Book hope to ride growing interest in more transparency in health care.

Launched in January, Healthcare Blue Book is the latest startup venture for Rice and Kampine. They worked together at CareSteps, a company that’s now part of Healthways, which helped consumers understand their health risks and get care according to evidence-based guidelines.

Healthcare Blue Book gets its revenues through advertising on its free site, including from health-care providers. It charges employers a fee for its customized program.

Rice, the company’s chief executive officer, said the Web site is especially helpful for consumers with high deductibles or limited medical plans that place more of the financial responsibility on them. “If you don’t ask before you get your care, you may be charged three or four times more than the fair price,” he said.

Danielle Gilbert, a Nashville resident enrolled in a high-deductible plan recently used Healthcare Blue Book to get the fair market price for an MRI related to a leg injury. She has started calling around to find a provider willing to accept that price. “If you’re willing to spend a little extra time, it’s a great service,” Gilbert said.

Health insurers may not be looking out for their employer customers

2009-04-30T19:25:00.000-07:00

Health insurers are supposed to be managing care to make sure employers get a good value for the money they and their employees invest in healthcare. Unfortunately employers haven't seen many rate reductions the past two decades.

In fact, insurers make a percentage of the total spend. The larger the spend, the more they make. Some may be starting to wonder if insurers would ever make real efforts to shrink the pie?

Providers have given discounts to insurers, but don't see any real value in the 'service' insurers provide. Now comes a lawsuit by one provider system claiming that 'big insurance' is collaborating with 'big providers' to make sure the pie grows over time. Specifically, West Penn Allegheny Health System is accusing rival University of Pittsburgh Medical Center of conspiring with Highmark Inc. to destroy the region's No. 2 hospital network and drive it out of business. The concern is that collectively they could raise rates and pass the increases on to employers and patients. See article.

Is it possible that an insurer would put its on long-term profits ahead the employers interest? Even pay the providers a little more to 'grow the pie'? What do you think?

Consider Prices Before You Receive a Test, Treatment or Surgery

2009-04-07T18:17:00.000-07:00

Employers offering higher deductible plans should help their employees learn to price healthcare services before they have them. Most employees don’t realize how much prices vary between different healthcare providers. Healthcarebluebook.com research found that the prices charged for the same test or treatment, even in the same market and within the same health plan, can vary by thousands of dollars. For example:

• In Chicago, IL prices for an MRI of the lumbar spine with contrast ranged from $500-$2661.00 among three hospitals and five imaging centers. (Healthcare Blue Book fair price is $522.00).
• In Washington, DC prices for an MRI of the right knee without contrast among five imaging centers ranged from $400-$1504 for the same test. (Healthcare Blue Book price is $912.00).
• In Nashville, TN prices for an MRI of the hip at five imaging centers ranged from $455 to $1302. (Healthcare Blue Book price – $507)

People are struggling to pay their medical bills and often suffer from sticker shock after they get the bill. Here are some steps that employers can share with their employees to help them get fair prices.

1. Ask the doctor to clearly explain the healthcare service you need. You should understand what you need done, why it’s important, and what options are available for where it can be performed. Don’t be afraid to ask your doctor, or another medical professional in that office, to be specific about the procedure or test and discuss it in plain language. There are also medical resources online such as WebMD and Mayo Clinic that will explain your treatment in less clinical terms.

2. Determine what a fair price is for your treatment or test in your market. Make sure you know how much services should cost. You can look up many healthcare services on the free consumer website at www.healthcarebluebook.com. Even when you get care from in-network providers, the prices you will pay for the exact same service, test or treatment can vary by 300-500 percent. Many employees assume they will pay a fair price if they stay in-network. Unfortunately this is not the case. While it is generally best to use in-network providers, employees still need to compare quality and prices.

3. Find out how much your provider charges. When possible, you should always ask your provider how much your treatment will cost before you receive care. Make sure to let your provider know which insurance company and plan type you have so he or she gives you the correct price. In some cases, you may have to call your insurance company to get a price. If your provider offers a reasonable price compared to the Healthcare Blue Book fair price, then you can be confident you are getting a good value. If their price is much higher than the fair price, then you may need to consider other options.

4. Compare prices from several providers. If you are uncomfortable with the value offered by your first provider, compare prices with other providers. Always start with in-network providers if you have a provider network. Call provider offices and request the price for the service. It is generally best to compare prices from 3 to 5 providers. And remember to consider different types of providers that can provide your service.

For example, if you need an MRI make sure to check prices at out-patient imaging centers. You may find a high quality center that charges $1000 to $2000 less than the high cost centers. If you need surgery, you may be able to have it performed at an Ambulatory Surgery Center (ASC) which can also save you as much as 50%. Fortunately, comparing prices usually only takes a few phone calls.

5. Get the agreed upon price in writing. If you are using out-of-network providers or if your provider quoted you a price that is different from its plan agreement, you should get a copy of the agreed upon charges in writing. This will eliminate problems that can arise if you receive an incorrect bill.

Companies of all sizes are struggling under the burden of skyrocketing healthcare costs. Consumer directed health plans (CDHP) and high deductible plans (HDHP) with health savings accounts (HSA) can save employers money but also require employees to be smart consumers. Employers can help their employees most by providing the tools they need to get fair prices.

Consumers Need Independent Healthcare Pricing Information

2009-03-31T08:48:00.001-07:00

Consumers continue to need independent sources for healthcare pricing information and the need is growing. Consumers are paying more and more out of pocket for their own care with increasing deductibles, co-pays, and co-insurance; Consumer Driven Health Plans (CDHP) plans and Health Savings Accounts (HSA); and the growing ranks of uninsured as the economy weakens. The healthcare industry continues to fail the consumer in providing pricing transparency. And recently, we see more evidence that some healthcare companies are crossing the line to actively disadvantage those paying for care.

The first example comes from the pharmaceutical industry as a settlement was announced between Baxter Health Corporation and the State of Wisconsin. Baxter allegedly reported average wholesale prices (“AWPs”) to pricing compendia for identified drugs that were grossly inflated and did not reflect the actual average wholesale prices. The inflated reports lead to increased costs for those purchasing the drugs. Baxter settled the lawsuit for a total amount of $1,050,000.

The settlement can be found here. Thirty five other pharmaceutical manufacturers have been charged as well.

The second example comes from California where The California Medical Association, American Medical Association and individual physicians have filed a lawsuit against WellPoint. The suit alleges that WellPoint colluded with Ingenix, a unit of United Health Group, on a price-fixing scheme that relied on an obscure database to set artificially low reimbursement rates for out-of-network care. "Health insurers are data manipulating to set rates artificially low, forcing patients to pay more than they bargained for when they go to a doctor of their choice," said Dr. Dev GnanaDev, CMA president.

Patients need to be careful consumers of the healthcare system. Prices vary a lot, even when patients stay in their insurer's network. When possible, patients should always ask about price before they get services. Then make sure the price you are offered is reasonable and fair. You can find fair prices for many healthcare services at the free consumer website: www.healthcarebluebook.com.

The Cost and Quality of Imaging

2009-03-03T10:59:00.000-08:00

The New York Times raises awareness of the variation in quality for imaging studies such as CT and MRI; however they miss some of the most important issues to improve quality and costs.

First, Insurers don't pay the same price for imaging regardless of where it is done. Most insurers pay different providers different prices, even in the same market for the same services. This is a fact that hurts even those patients with insurance. Pricing of MRIs and other tests even within a single market and for a single insurer usually vary a lot. We recently helped a patient schedule an MRI. The first imaging center wanted $2,500, by calling around we found a high-quality center that charged just under $500. This dropped the patients 20% coinsurance amount from $500 to $100.

Second, paying a higher price for your healthcare does not mean you are getting higher quality care. Often the opposite is the case. Many high volume centers that do it right the first time will also have lower costs for patients.

And most importantly, when patients don't ask about price they usually don't ask about quality either. When patients engage in choosing a provider they tend to ask about both cost and quality.

I suggest that any time you need to have a test, surgery, procedure, etc. you shop around. The Healthcare Blue Book can tell you what the fair price for a service is in your market. Then you can call several facilities in your area and ask what type of machine will be used, how old it is and what the cost is.

Just as consumers must ask questions about quality, they also need to ask questions about price.

Lawsuits may impact pricing transparency.

2009-02-15T13:42:00.000-08:00

A crop of lawsuits highlights the difficulty of determining reasonable provider payment rates. Providers will always want higher reimbursements while insurance companies aim to pay the least amount possible. Unfortunately for consumers, when you are using out of network providers you may get stuck in the middle.

Many insurers use the Ingenix pricing guide to determine “customary” fees. The Ingenix guide is ultimately owned by United. It seems to work well for the insurers; maybe not for providers and consumers. Thus the lawsuits.

AMA sues UnitedHealth – Settlement $350M - The AMA and others claimed that UnitedHealth underpaid physicians and shortchanged consumers when paying out of network claims.

AMA is now suing both Cigna and Aetna on similar claims.

New York AG Andrew Cuomo settles with UnitedHealth- Settlement $50M – This settlement will be used to build a public database to track provider fees and ultimately United will discontinue the Ingenix pricing products in this area.

New York AG Andrew Cuomo settles with Aetna- Settlement $20M- Aetna settlement contributes to the development of the public database and will stop using the Ingenix pricing databases.

Reports state that Cuomo has subpoenaed Cigna, WellPoint and others. No settlements or resolution yet on those.

We’ll keep a watch out for additional settlements, the development of the public database and how this may help consumers.

update 2/18/09: New York AG Andrew Cuomo settles with Wellpoint - Settlment $10M - Wellpoint now joins other larger insurers by paying $10M to the yet to be created nonprofit database company.

WellPoint’s subsidiary Empire BlueCross Blue Shield (“Empire”) is the largest health insurer in New York State, with approximately five million members.

The Nonprofit database company has yet to be selected or announced. We'll stay tuned.

Physician Medicare Data Will Not Be Transparent

2009-02-04T05:30:00.000-08:00

An appeals court just rejected a request to allow disclosure of Medicare data related to physician services. This is not a helpful ruling for those interested in increasing transparency of quality and costs in healthcare.

The Doctors: The American Medical Association representing the doctors asserts that doctors have a right to privacy so the data should remain private. And by the way, the information isn't perfect, so we wouldn't want to confuse consumers with information they probably can't understand.

The Government: The government has made many statements and taken actions to increase transparency (the new administration as upped the volume on 'open government'), yet Health and Human Services - HHS- stood in opposition to disclosure of this information. This is in contrast to their use of Medicare data disclosures for hospitals which they provide here.

The Judges: The lower court had ruled for disclosure of the information. The new court ruled that freedom-of-information laws are mainly intended to shed light on government operations, not the workings of private businesses. The government spends billions of dollars on healthcare services representing one of the larger and faster growing portions of the overall budget. It is hard to miss the connection to the government's operations.

Next Steps: The nonprofit Consumers' Checkbook group who brought the case is considering an appeal.

When a person contracts with the government, they might expect the terms of those dealings to be made open to the public. If a physician accepts payment from the public, does the public have a right to know about those payments? And do we really think information must be perfect before we disclose it? Do we want our government deciding which information we should get?

Unfortunately, the ruling goes against the trends towards increased transparency in healthcare. Let's hope the issue doesn't end here.

The Impact of Insurance on Healthcare Costs

2009-01-28T17:53:00.000-08:00

It is well known consumers will demand more services if they don’t have to directly pay for them. It is also well known that there are large administrative costs and risk premiums included in insurance. That is why we don’t insure our cars for the periodic oil change or tire replacements. And yet, we routinely expect health insurance to cover the most trivial of services like check ups and routine care. But at what additional costs?

I would recommend reading Holman W. Jenkins, Jr. insightful argument published in the WSJ on January 21, 2009 “Can Obama Make Government Solvent”. In part he states:

“End the tax preference for employer-provided health care. Make it up to workers with an income or payroll tax cut. This one step would move the economy towards consuming health care efficiently and designing insurance policies that actually insure rather than channel the privileged class's health spending through a tax loophole.

The privileged class, exposed to meaningful price tags, would become a force for disciplining cost and quality rather than the opposite. Nothing else would so improve the country's long-term fiscal prospects or do more to lend practicality to Mr. Obama's goal of universal coverage.

Back in 1993, when minds were still fresh, economists left and right recognized that the enormous tax subsidy to third-party payership was the original sin of our health-care woes. The Senate Finance Committee devoted a full set of hearings to just this issue. But it was a fix that lacked the grandiosity of a flow chart showing how government would re-engineer health care from top to bottom. There's a lesson here: Real reform is often deceptively simple, leading naturally to changes in behavior that are more far-reaching than any detailed government prescription could hope to achieve.”

The decisions our current government makes will have a large impact on the cost, quality and availability of healthcare in the future.

Healthcare Blue Book

2009-01-19T12:04:00.000-08:00

Welcome to my new blog on Healthcare Transparency.

This blog is being launched to coincide with our new website: www.healthcarebluebook.com

I will blog about transparency in healthcare. The focus will be on news and issues important to the healthcare industry and healthcare consumers. While pricing is important, I will also focus on quality of care transparency as well. In my experience, when providers don’t compete on prices, they generally don’t compete on quality either.

I’d like to invite all readers with an interest in healthcare price transparency, consumerism and quality measurement to check in frequently and to share your perspectives, experiences, questions and news. I would like this blog to be the bellwether of emerging price transparency issues, and a shared community resource.

I invite you to review the Healthcare Blue Book and the company’s first release:

Healthcarebluebook.com: New Web Site Teaches How to Price Shop

Contacts: Dr. Jeff Rice, Healthcarebluebook.com, 615-473-1773, jrice@healthcarebluebook.com
Aimee Stern, Stern Communications, 202-744-5004, aimee@sterncommdc.com

January 7, 2009, Nashville, TN. Americans can’t control the economy, but they can do a much better job of educating themselves about what they should pay for healthcare. The Healthcare Blue Book, www.healthcarebluebook.com, the first national effort to provide free pricing data to consumers launches today, and is designed to give people the information they need to pay fair prices for healthcare.

Price variations for healthcare services, even within the same market and provider network, may be thousands of dollars. So knowing what the fair price is can help consumers better manage the cost of their healthcare.

Healthcarebluebook.com is easy to use. Type in the kind of healthcare service needed plus a zip code and the Healthcare Blue Book pulls up the fair price based on fees paid by Preferred Provider Organizations (PPO) to doctors for services in that market. Consumers can then use the suggested Healthcare Blue Book price to discuss prices for services and treatments with their doctors and other healthcare providers.

Healthcarebluebook.com also offers a customized application to employers that supports implementation of consumer directed health plans (CDHP), high deductible health plans (HDHP) and health savings accounts (HSA) among other consumer benefits designs. Applications are built depending upon the types of healthcare services employees use, and what in and out of network PPO and other healthcare providers charge for these services.
Healthcare costs are expected to continue climbing throughout 2009. The National Survey of Employer-Sponsored Health Plans conducted by Mercer, reported that in 2008, PPO deductibles doubled at many companies from $500 to $1,000.

Americans do price/value comparisons for their homes, cars, vacations and the majority of goods and services they buy. “Why not healthcare?” asks Dr. Jeff Rice, Healthcarebluebook.com founder. The former CEO of CareSteps, Rice has a long history in the healthcare industry of developing innovative products for consumers.

“Patients should not assume that a high price means good quality,” says Rice. “It is up to patients to ask about the cost of services and to learn about the quality of their providers. Doctors and hospitals that charge a fair price, often provide the best value. Healthcarebluebook.com can help consumers figure out what they should pay.”

Consumers need better education about the healthcare services they purchase and 2009 is a good year for them to start. Using Healthcarebluebook.com can help people learn how to obtain fair prices for their healthcare.

CareOperative LLC provides the information, tools and processes that enable fair, upfront pricing for healthcare services and products. As parent company of www.Healthcarebluebook.com, it has developed a consumer friendly guide to find fair prices for healthcare services. Employers can use the Healthcare Blue Book to help their employees more effectively manage the cost of their healthcare.