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)
Tuesday, June 23, 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.
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