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.
Thursday, December 17, 2009
Saturday, December 12, 2009
Everything Old Is New Again
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
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
Wednesday, November 18, 2009
Facility Surcharge for Doctor Visits
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
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
Sunday, November 8, 2009
$100M Healthcare Pricing Database
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.
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.
Wednesday, October 21, 2009
Public Option To Have Pricing Subsidy
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.
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.
Wednesday, October 7, 2009
FeelingFlu.com
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
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
Monday, October 5, 2009
Too Much Care?
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.
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.
Friday, September 25, 2009
Will Anyone Know the Price of Their Drugs?
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.
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.
Thursday, September 17, 2009
First Know the Problem, Then Fix It
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.
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.
Thursday, August 27, 2009
Pricing Transparency In Minnesota
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.
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.
Wednesday, August 19, 2009
Americans can agree on many healthcare reforms
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.
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.
Friday, July 31, 2009
The Public Option
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?
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?
Monday, July 20, 2009
Obama speaks out on health reform: Do his words match the reality?
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.
"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.
Tuesday, June 23, 2009
Quality and Cost: Do you get what you pay for?
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)
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)
Wednesday, June 10, 2009
ACE Pilot for Consumerism and Value Based Purchasing
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.
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.
Sunday, May 31, 2009
101 Ways To The Best Medical Care
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.
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.
Tuesday, May 19, 2009
Healthcare Blue Book In The News
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.
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.
Thursday, April 30, 2009
Health insurers may not be looking out for their employer customers
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?
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?
Tuesday, April 7, 2009
Consider Prices Before You Receive a Test, Treatment or Surgery
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.
• 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.
Tuesday, March 31, 2009
Consumers Need Independent Healthcare Pricing Information
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 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.
Tuesday, March 3, 2009
The Cost and Quality of Imaging
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.
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.
Sunday, February 15, 2009
Lawsuits may impact pricing transparency.
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.
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.
Wednesday, February 4, 2009
Physician Medicare Data Will Not Be Transparent
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 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.
Wednesday, January 28, 2009
The Impact of Insurance on Healthcare Costs
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:
The decisions our current government makes will have a large impact on the cost, quality and availability of healthcare in the future.
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.
Monday, January 19, 2009
Healthcare Blue Book
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.
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.
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