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Quality is Not Just About Price
Affordable Lab Tests
More Truths About Hidden Health Care Prices
Avoid Paying Inflated Health Care Costs
What You Need to Know to Find Affordable Health Care Services

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The opinions expressed herein are my own personal opinions and do not represent my employer's view in any way.

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 Wednesday, November 26, 2008
Quality is Not Just About Price
Wednesday, November 26, 2008 2:45:53 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Finding the Best Value for Health Care Services )

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


 

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 Tuesday, November 25, 2008
Affordable Lab Tests
Tuesday, November 25, 2008 10:19:29 AM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Finding the Best Value for Health Care Services | High deductible Health Insurance | Transforming Healthcare | Transparency )

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

 

 

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 Monday, November 24, 2008
More Truths About Hidden Health Care Prices
Monday, November 24, 2008 1:57:52 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Finding the Best Value for Health Care Services | Transparency )
A recent blog post on Health as Human Capital Foundation shares an interesting research summary on hidden health care prices. The research focuses on an employer that analyzed their employee health care costs and spending patterns for MRIs of the knee. They analyzed MRI costs from six local facilities in one metropolitan area and here’s what was identified:
  • 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.

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 Friday, November 21, 2008
Avoid Paying Inflated Health Care Costs
Friday, November 21, 2008 2:53:53 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Finding the Best Value for Health Care Services )

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.

 

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 Monday, November 17, 2008
What You Need to Know to Find Affordable Health Care Services
Monday, November 17, 2008 1:45:28 PM (Central Standard Time, UTC-06:00) ( Finding the Best Value for Health Care Services | Transparency )

How much does an MRI of the brain cost?  What would I pay for a CT-scan?  What provider offers the best price for an ultrasound?

 

Every week you shop for goods/services, and make choices based on what is a “good value.”  When you make these purchase decisions, you use the skills you have (without even thinking about it) to find the best value.  The same rules apply when you are trying to make the most of your healthcare dollars.   It doesn’t matter if you are shopping for prescription medications, durable medical equipment, providers, diagnostic tests or vaccinations.  Obviously in an emergency situation these rules do not apply, but for routine service you need to put on your consumer hat and apply some simple rules.  If you do not follow these rules, you will end up overpaying for services.   Our healthcare system charges consumers up to 300% more for the exact same service and if you aren’t informed there’s a good change you will overpay.  Would you rather spend less on healthcare and more on family vacations?

 

Three things you need to remember when shopping for health care services:

Shop around.  Apply your consumer-savvy skills to comparison shop and find out what other consumers paid for similar services.  Providers charge hundreds of different prices for the exact same service.  Make sure you find the best price and get the best value.  Talk to other consumers and find out where people went for services and what they thought of the provider.  Were the prices fair?  

Ask lots of questions.  Don’t be afraid to ask providers and your insurance plan questions like “how much will this service cost me? “  Ask friends, family, community groups where they would go to get the best value for a specific service/treatment. Information can be powerful.

Use resources available.  Make the most of tools available to you via websites, insurance plans, health content sites, community sites and blogs.  If your health insurance plan provides cost estimator tools, be sure to check these out. They are not always meaningful, but worth looking into.  The more you know, the better informed you will be.  For me the most effective way to get actual prices is to call the insurance plan and the provider directly and ask them how much this service will cost me.  You can also use websites that provide pricing to understand what others paid for similar services.  Most importantly, don’t be afraid to ask for a price and if necessary, as for a discount.

The Boston Globe Spotlight Team reported on a story about pricing discrepancies in our healthcare system.  They obtained actual private insurance data in their research to analyze provider prices for the exact same service and compared these prices with providers in Massachusetts.  Here’s a summary of what they found:

InPatient Services Coronary Bypass Hip Replacement Pneumonia
Average price in Massachusetts $43,514 $19,256 $5,695
Massachusetts General Hospital $51,522 $23,197 $6,789
Brighan and Women's Hospital $47,138 $24,552 $7,936
Tufts Medical Center $40,486 n/a n/a
Boston Medical Center $33,988 n/a n/a
Beth Israel Deaconess Medical Center $43,514 $21,627 $6,389
Lahey Clinic $43,857 $20,175 $6,127
Northeast Health System, Beverly Hospital n/a $18,299 $5,695
South Shore Hospital n/a n/a $6,311
Brockton Hospital n/a n/a $5,052
Winchester Hospital n/a n/a $4,814
OutPatient Services  MRI of Brain   CT Scan of Chest   Ultrasound, 1st trimester 
Average price in Massachusetts $693 $482 $129
Massachusetts General Hospital $1,153 $838 n/a
Brighan and Women's Hospital $1,118 $838 $263
Tufts Medical Center $638 $478 $117
Boston Medical Center $557 $418 $86
Beth Israel Deaconess Medical Center $855 $642 $201
Lahey Clinic $704 $513 n/a
Northeast Health System, Beverly Hospital n/a $504 $148
South Shore Hospital $835 $519 $163
Brockton Hospital $590 $443 $139
Winchester Hospital $716 $537 $168

 

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