Happy New Year!  Spending wisely for health care services is definitely a priority in 2009 and with a little knowledge; you can easily save hundreds –even thousands of dollars.   To get you started, here are some excellent tips on how you can save money on routine health care services. 

Affordable Medical Care Services

Federally-funded by the Health Resources and Services Administration (HRSA), there are thousands of health centers around the U.S. that provide low-cost health care to people based on financial need. You pay what you can afford, based on your income. For more information visit www.findahealthcenter.hrsa.gov, or you can call (888) 275-4772.

Hill-Burton facilities: There are around 200 Hill-Burton health care facilities around the country that offer free or reduced-cost health care for people that cannot afford to pay for services.  To locate a facility or to see if you qualify, visit www.hrsa.gov/hillburton or call 800-638-0742.

Free clinics: These are privately funded, non-profit, community-based clinics that typically provide care for common illnesses and injuries to those in need, at little or no cost. There are around 1,000 free clinics nationwide. To locate one in your area, call your local hospital or visit www.freemedicalcamps.com for more information.

Indian Health Service (IHS): A government agency within the Department of Health and Human Service, IHS provides free medical care to American Indians and Alaska Natives in 35 states. Visit www.ihs.gov for more information.

Remote Area Medical: A non-profit, charitable organization that provides free health, dental and eye care to uninsured or underinsured people in remote areas of Tennessee, Kentucky and Virginia but may be expanding to other states in the future. Visit www.ramusa.org or call (865) 579-1530.

Making Sense Out of Existing Data

Did you know that health care price data exists today --it's just not available to the public. I am passionate about bringing consumerism to health care, and dedicated to promoting price transparency.  My goal is to make sense of the existing price data to help consumers make informed choices. 

For CONSUMERS

• Hunting down true out-of-pocket expenses for health care services – in advance, can be frustrating.  Unless you are an experienced data minter, this type of hunting can be intimidating and time-consuming.  If you are uninsured, under-insured, looking for an out-of-network provider, or have a high-deductible health plan, you are probably trying to make cost-effective choices before purchasing health care services.  And you are probably interested in knowing your true out of pocket cost for the services BEFORE you visit the provider.    That’s just being a good consumer.  You need useful and relevant tools to help you make good choices.

For INSURERS

• You are the keeper of all the claims data for your members.  You know exactly the negotiated (contracted) price for every provider, for every service, for every different insurance plan you offer.  You also know how much of a member’s deductible has been met.  You have databases of prices paid for every service for every member and could make life a lot easier for your members and possibly change health care if you agreed to share this data to make it publically available.  Yet you insist on keeping this data a secret. 

For OUTOFPOCKET.COM

• I am inviting consumers to post/share prices they paid in the directory.   Everyone wants to look up prices, but very few are willing to take a minute to post/share their prices.  We could wait years for legislation to pass, insurers to agree to make prices public, or we could do something today.  Consumers are invited (and encouraged!) to collaborate and share prices they paid on OutofPocket.com.  If enough consumers participate and share prices, consumers collectively will create a very powerful directory of true out-of-pocket prices.

For PROVIDERS

• You have an opportunity to transform health care as we know it today.  You can help promote transparency by publishing your prices for services.   Why not let consumers know up front what your services will cost them?  OutofPocket.com invites you to include your prices/services in the directory - free of charge.  This not only promotes your practice, but also helps consumers understand what they will be required to pay for services at your facility.

Imagine how easy it would be to comparison shop for health care services if relevant data was available. If consumers had access to true healthcare price data, comparison shopping for health care services could be a lot like your experience shopping for a book on Amazon.com, booking a vacation on Travelocity.com or purchasing an item on eBay.com. 

Tell a friend about OutofPocket.com and be sure to add prices you paid for health care services to this directory.   Not only will you be sharing data, but you will be contributing to a powerful directory of prices that will help promote more affordable health care services.

Doctor Review Websites

The November 28 edition of Slate.com included an interesting article by Dr. Kent Sepkowitz.  His article sheds some light on all the doctor rating websites available today.  Dr. Sepkowitz spent many hours reviewing doctor rating tools, including free sites and sites that require subscriptions or fees to obtain this information.  His conclusion:  the online doctor rating tools are very lean, content-free and lack any useful information. 

Last month I posted a blog about finding the best value (understanding the quality side of health care in addition to finding the best cost) and listed 25 different websites that offer doctor ratings.  I neglected to mention that I never use these doctor rating sites because they are not useful.   They lack meaningful data.  All of them.  Instead, I ask my doctors, family, friends, and community for their personal recommendations.  Then I go online and start to research the doctor’s certifications in more detail using many websites, tools and blogs to read other patient’s comments and experiences.  Since this is user generated content, you need to be able to read between the lines.  Sometimes people just have a bad day and they should skip writing reviews online until they have 24 hours to think about what they want to write and their mood stabilizes.

Price Transparency Tools

I am dedicated to promoting price transparency in health care.  This is what I do and that’s why I launched OutofPocket.com almost two years ago.  If I can help consumers make more informed and cost-effective choices before visiting a provider, then I have accomplished my mission.   When consumers start making more informed choices, become active participants in their own health care and demand greater transparency  --- good things result including lower costs, more innovation, more choices and improved access to medical care.
 
OutofPocket.com is not the only price transparency tool available.  Dozens of others are out there and I research all the new tools to evaluate their usefulness so I can talk about these tools in my next presentation.  Unfortunately, the price transparency tools seem to have the same disease as the doctor rating tools.  Each has some amount of data, but not enough to be meaningful and comprehensive.  Wouldn’t it be interesting if these tools collaborated and consolidated their data to produce a robust tool where shopping for routine health care servcies would be comparable to the experience of shopping for items using eBay or Amazon.com, where you can easily compare quality, prices and recommendations?

Here is the short list of 20 price transparency tools.  If you would like my comprehensive list and review of each tool, please send me a note and I’d be happy to forward this information to you.

Alijor
AMA CPT Lookup Tool
Carol
CostHelper
DoctorPricing
HealthcareBlueBook
HealthPricer
HospitalVictims
MainStreet Medica
MedcareCompare
MyHealthScore
MyMedical Costs
MyRegence
OutofPocket
PatientCare
RemakeHealth
Spectrum Health
UCompreHealthCare
USA Healthcare Costs
Vimo

Doctor Ratings

I love the idea of empowering consumers to exercise choice, encouraging them to become an active participant in making decisions about their health care, and incenting them to find the best value before seeking health care services.  It’s important to note that value is about quality and price so if you end up finding the lowest-cost provider, but the quality of service is less than desirable – you have not found a good value.  I often use recommendations from family, friends and community members when researching a new doctor, facility or hospital.  Asking consumer’s questions like, “what did you think of that doctor? Would you recommend their services? What didn’t you like about the facility?”  These are all very helpful questions for you to ask when trying to learn about a new provider.   

If you’d rather use online tools to lookup recommendations and ratings of doctors, there are a number of sources available.  For additional information, you can read a white paper on MD Rating Websites: Current State of the Space and Future Prospects.  Ruth Given has written a 39-page analysis that takes a comprehensive look at many of the doctor rating sites that exist today.

Here’s a list of doctor rating websites to get you started.

alijor.com

angieslist.com

bookofdoctors.com

careseek.com

checkMD.com

doctorfeedback.com

doctorscorecard.com

drscore.com

findadoc.com

healthcare.com

healthgrades.com

healthworldweb.com

kudzu.com

mdnationwide.org

mydochub.com

ratemds.com

remarkabledocs.org

revolutionhealth.com

suggestadoctor.com

thehealthcarescoop.com

vimo.com

vitals.com

wellness.com

whitecollarfinder.com

zocdoc.com

Do you know how to find affordable lab tests?

Fortunately I have good health insurance.  Four years ago I signed up for a high-deductible health plan for my family in order to keep our premiums down.  My deductible is $5,200 and as a result, I am getting really good at shopping around for the best value, negotiating cash prices with providers, calling around to get prices and using available tools/resources to comparison shop/understand fair prices.  The more money I am able to save on finding affordable health care, the more money I have to spend on family vacations.  That’s enough incentive for me.

My health insurer has negotiated special deals (discounts) with providers in my network.   When I use these network providers, I am charged the discounted rate for services.  This carefully guarded rate is difficult to find out until after services are provided because health insurers keep negotiated prices a secret.  That’s why I encourage consumers to post/share rates they paid for actual services in OutofPocket.com directory, to share with other consumers.  If insurers and providers will not reveal these prices, consumers should!

I recently had a series of blood tests done that were required for my upcoming surgery.  I realized if I went to my doctors office to have these blood tests taken, my out-of-pocket costs would be much higher, so I selected a stand-alone lab testing facility that offers affordable lab tests.  I went online to find Quest Diagnostics and scheduled my appointment.  I just received my EOB and here’s what I discovered

Prices For My Lab Tests for Comprehensive Blood Test

Total Quest Labs billed to my insurance plan      $ 193.78

Total discounted by my insurance plan                 $ 143.78

Amount of my out-of-pocket for my lab tests         $   50.00

If I wasn’t careful, I could have easily ended up paying a lot more for my lab tests.  If I did not have insurance, I would have negotiated a cash discount with the lab when I scheduled the service, to make sure I get a fair price.  Because of my cost-effective choices, I saved about $144.

Here are some resources you can use to find affordable lab tests in your area.

www.PrivateMDLabs.com

www.MedLabUSA.com

www.DirectLabs.com

www.LabSafe.com

www.MyMedLab.com

www.QuestDiagnostics.com

• Amounts paid by the employers two health insurance companies for MRIs ranged from below $700 to more than $2,400
• Amount billed to the employer’s insurance companies (before discounts were applied) ranged from $1,100 to over $4,000
• Approximately 300 MRIs were done annually in this population. If employees were to choose the lowest-cost provider for an MRI instead of the highest-cost provider, it would save the employer about a half a million dollars per year for just one type of diagnostic procedure
• If an individual consumer shops around for the best price for an MRI, they can save themselves hundreds of dollars on this diagnostic test. If all employers/employees in one city shopped around for the best value, imagine how many hundreds of millions of dollars per year could be saved on health care costs just by choosing the lowest-cost providers?
• Why don’t employers simply require their employees go to the lowest-cost provider? The employees don’t know who the lowest-cost provider is. This information is not available. Health plans carefully guard ‘secret’ payment information because they have different negotiated prices with different providers. They don’t want one provider to discover that another provider is being reimbursed more for the exact same procedures. So when an employer chooses a health plan for its employees, the negotiated prices for services are already set. Services provided will be reimbursed at the plan’s negotiated amount (whatever that is).

Other interesting facts

• The rate of MRIs has tripled over the past ten years
• One-third of the MRIs provided are considered unnecessary
• MRIs generate significant revenue for health care facilities. Often there are financial incentives encouraging their use
• Studies indicate that radiology costs (includes x-rays, MRIs, CT scans) have risen faster than any other category of health care costs

Consumers --- do your homework and research prices BEFORE visiting a provider. Use available tools, make phone calls and compare prices and quality before you decide on a provider. You can save yourself hundreds, and possibly thousands of dollars annually.

Employers -- provide comparison shopping tools for your employees to use to help them make informed choices. Employers can also encourage and incent employees to make cost-effective choices. This not only reduces health care expenses for employees, but also reduces employer health care costs. A win-win situation.

Today there are about 46 million uninsured Americans and this number continues to increase as the recently unemployed lose their jobs and join the uninsured.   In these tough economic times, you have to ask yourself “how do all these uninsured consumers shop for affordable health care services when they need medical attention?”  Regardless if you are uninsured or insured, how much more can you afford to spend on out-of-pocket costs?  Many of us are living on very tight budgets and need to make the most of our health care dollars.  Protecting ourselves from being overcharged for medical costs and finding affordable health care service is more important today than ever before.

With the holidays approaching in this economic downturn, consumers are responding by tightening their budgets, becoming more cost conscious and relying more heavily on comparison shopping engines to help them shop around for the best value.  The same behavior applies to shopping for health care services.  Unfortunately most consumers have no idea how to comparison shop for health care services.

A new start-up, Out-of-Pocket Protector, works with consumers to protect them from inflated costs and billing errors.  If you have read my earlier posts you already know that I strongly encourage consumers to do research upfront --before you even visit a provider, to make sure you negotiate a fair price for service.  If for some reason you skip the research step and find yourself needing a second opinion to review your medical bills for errors, and possible overcharges, there are a number of services to help you through this process.  Ideally, consumers would take charge of this on their own, but if you feel intimated by the whole process, you can take comfort in knowing that services are available to help you.  These services often charge membership fees or charge you a percentage of the money they are able to save you.  One such service is called Out-of-Pocket Protector (no relation to OutofPocket.com).  According to Out-of-Pocket Protector, what sets them apart from competitors is their “focus on the whole process, from finding and negotiating affordable care upfront, to offering consumers a second opinion on their medical bills after they receive care.  The vast majority of consumers want to promptly pay a fair price for the health care they receive.  With help, that’s just what our members are able to do.” Membership for this service is $14.95/month or $165/year.  If you would like more information on this service visit www.outofpocketprotector.com.

If you have a health insurance deductible to satisfy, or if you are enrolled in a consumer driven healthcare plan, or if you have out-of-pocket costs that add up to more than $25/visit, I am sure you try to make the most of your health care dollars by finding low-cost providers that offer  the best value.  How do you find these low-cost providers?

Starting November 1^st, I am polling the community to find out how you search for health care prices.  I am interested in understanding how different consumers search for low-cost healthcare prices. What tools do you use to compare prices for health care services?  What “search terms” do you type in Google to find prices for health care services?

Let’s assume you visited your doctor and you need to have a non-emergency test or procedure performed.   How do you go about your search to compare prices for services like MRIs, x-rays, mammograms, vaccinations, lab tests, or a colonoscopy?  Do you ask your doctor for estimated prices?  Do you call the hospital or facility and ask for prices?  Do you ask your family, friends or neighbor to compare what they paid?  Do you call your health insurance hot-line for prices and recommendation on where to get the best value for this service?  Do you use Google to search?  If so, what search terms do you use? 

Send me an email to let me know what search terms you would use (or have used) to look-up and compare health care prices for specific services.   The first 1,000 people to respond will be entered in a drawing for a chance to win a $50 Amazon.com gift certificate.  Email entries will be accepted through November 30, 2008.

Here are the details to be included in the drawing for the $50 Amazon gift card.  Send an email to info@OutofPocket.com  and in your email message be sure to include:

(1)   What specific resources you would use (search engines, websites, online tools)

(2)   What search terms you would use to find prices for health care services

(3)   An email address where we can contact you, to notify you if you win the drawing

Good luck and thanks for sharing your search tips with us. 

If you are wondering what the true cost of an appendectomy is, keep reading....  Jaz-Michael King’s blog, A Scanner Brightly, provides the most thorough detail I have ever read on a patient’s charges for an appendectomy.  He wrote this blog earlier this year, and itemized the specific charges related to his appendectomy procedure.  A huge thank you to Jaz-Michael for sharing this detail with everyone to help us become better health care consumers.  I am glad everything turned out fine for Jaz-Michael and I would like to encourage him to keep up the great blog.  The data he shares is a wealth of information for consumers.

You definitely should read his blog entry, Hospital Bill: Appendix Ultimatum - it includes his comments and other useful information on the breakdown of costs for this procedure. 

Here are the itemized charges for an emergency appendectomy.