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300 “Shoppable” Health Care Procedures
Top Ten Tips to Save Money on Medical Care
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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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 Tuesday, February 28, 2012
300 “Shoppable” Health Care Procedures
Tuesday, February 28, 2012 12:59:07 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Transparency )
According to a recent white paper published by Thomson Reuters, $36 billion dollars annually is wasted on health care procedures that are considered shoppable. These procedures are defined as shoppable because they are high-volume, non-urgent procedures and treatments that consumers would plan for and schedule in advance, like a mammogram, colonoscopy or MRI.

Some key findings in this paper include:
  • Prices for these services are often 2-3 times higher than the median price for the exact same procedure.
  • If the industry were to reduce prices for 300 common procedures to their median price nationwide, total medical expenses would be reduced by 3.5%, or $36 billion annually
  • A major driver of price variation is the site of service; prices vary significantly by care setting and the percentage of services done in the hospital verses an office setting. 
Both the consumer and the provider are in the dark about health care pricing. If and when the marketplace supports transparency, providers will be able to set their price more rationally and consumers can be better shoppers of health care services.

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 Tuesday, February 21, 2012
Top Ten Tips to Save Money on Medical Care
Tuesday, February 21, 2012 11:53:06 AM (Central Standard Time, UTC-06:00) ( Finding the Best Value for Health Care Services | Transparency )

Peter McIntire recently launched SelfPayMRI.com, an online portal that helps consumers discover and schedule affordable imaging and diagnostic testing.   He published a list of top-ten tips to help consumers save money on their medical care.  Link to his full blog post.

Peter’s top ten list of tips to help consumers save money their medical care.

1.     Hospital owned providers and facilities have less flexibility in providing big discounts to self-pay patients.

2.     In most markets, there is an oversupply of ancillary providers (imaging, labs, home health, medical equipment, etc.)  Use this fact when negotiating.

3.     The more flexible you are for the appointment date and time, the better deal you will get.  Don’t ask for a Monday AM or Friday AM appointment, these are their busy times.

4.     Always state you will pay 100% at time of service and most importantly do!  This alone cuts 3% -8% off of a provider’s cost to perform services.

5.     Facilities that rely on doctor referrals like to “take care” of their mutual self pay patients.  Telling a facility what doctor you have the order from may help you with your final price.

6.     Know your pricing reference points – see this post.

7.     If you need a procedure that is done by a doctor in a setting other than the doctor’s office, ask your doctor for the most affordable site location.  In general, a procedure done in an outpatient surgery center is less than if done in the hospital setting.

8.     Plan ahead and do your due diligence for those medical services that are non-emergency.  Don’t wait until the last minute to price your service.

9.     If you don’t feel a bit embarrassed about your offer, you are probably not asking for a low enough deal!

10.  Above all is quality!  Concentrate on the quality providers with national accreditation, board certifications, and appropriate fellowships.  For example, the lowest price MRI listed on SelfPayMRI.com might not be the best for your situation – review accreditation, doctor bios, and their websites.


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 Tuesday, February 07, 2012
Health care in America
Tuesday, February 07, 2012 4:03:38 PM (Central Standard Time, UTC-06:00) ( Consumer-driven health care | Finding the Best Value for Health Care Services | Transparency )
This article explains how companies are attempting to make health care costs transparent for their employees.  The full article, Companies Try to Make Health-care Costs Transparent, was published in The Economist on February 4, 2012. 

If you receive health insurance from your employer, you may already have access to useful tools that help you understand health care costs, enable you to comparison shop for prices, and assist you with finding the best value ----before you visit a provider.  If this does not describe how you shop for health care services, you will know what I am talking about after you read this article.

AMERICANS spent $2.6 trillion on health care in 2010, a staggering 18% of GDP. Yet few of them have the faintest idea what any treatment costs or how it compares with any other treatment. Prices vary wildly and seemingly without reason. Insurance terms require a dictionary. For most Americans, buying a procedure is akin to choosing a house blindfolded, signing a mortgage in Aramaic, then discovering the price later. Slowly, however, this is changing.

The past decade has seen a shift in how people pay for medicine. Americans’ health spending is growing at a slower pace. This is partly because of the downturn, but not entirely. The rate of growth fell every year between 2002 and 2009, note David Knott and Rodney Zemmel of McKinsey & Company, a consultancy. There are many reasons for this—for example, many costly drugs have lost their patents. But spending habits also seem to be changing.

Most American workers receive health insurance through their employers. They typically shoulder the costs without realizing it. The more a company spends on health insurance, the less is left over to pay wages. Now employers are trying to give staff an incentive to think hard about costs.

Under “consumer-driven health plans”, workers must cough up part of the price of any treatment before their insurance coverage kicks in. Most have an untaxed account to spend on health; they think twice before depleting it. In 2006 only 10% of workers had to pay at least $1,000 before their insurer picked up the rest of the bill. By 2010 that share had more than tripled.

General Electric (GE) shifted its salaried employees into consumer-driven plans in 2010. It urged them to shop around for bargains, but they found this nearly impossible due to a lack of information. “People started saying: ‘If you want me to be an active consumer, I need to know prices,’” explains Virginia Proestakes, the head of GE’s benefits program. When employees asked doctors for prices, the doctors were baffled. They had no clue how much different insurers paid for the same procedure, or what share a patient would pay. A recent study by the Government Accountability Office (GAO), a public watchdog, reported similar problems.

Barack Obama’s health reform requires hospitals to list standard prices each year, and more than 30 states have either proposed or passed laws to promote price transparency, according to the GAO. None of these measures has come close to solving the problem. Few provide enough data to allow people to shop around.

So private firms are having a go. GE, for example, hired Thomson Reuters, an information firm, to show employees the cost of different services. Thomson Reuters analyses prices from prior purchases—by workers at GE and other firms—to show the cost of a given procedure at different hospitals and clinics.

Another company, Castlight Health of California, has made transparency its sole mission. Working with big firms, Castlight assembles data from past transactions so that employees can shop for doctors online and read reviews posted by patients. Castlight wants to do for health what Travelocity did for air travel, explains Giovanni Colella, the founder. Mr Colella’s co-founder is now the chief technology officer for Mr. Obama’s health department.

These plans face several obstacles. Health care is more complicated than flying. A traveler knows she wants to get from A to B, and that more or less any airline will get her there in one piece. So it is easy to rank air tickets by price. By contrast, someone with a heart problem may be unsure whether to pop pills, operate, change his diet or do nothing. Informed medical decisions require a ton of information.

To make matters worse, health insurers are reluctant to share data about costs, says Bobbi Coluni, who leads Thomson Reuters’s consumer-health unit. If an insurer has a contract to pay one hospital $7,000 for a caesarean and a contract to pay another hospital $10,000 for the same service, and this information leaks, the first hospital will lobby for a higher price. GE’s contracts with insurers stipulate that GE owns the data from workers’ past health purchases. But such agreements are rare.

Despite this, greater transparency seems inevitable. Smart insurers are hawking their own tools. Cigna uses Thomson Reuters’s technology to support its “cost of care estimator”. Aetna, another insurer, offers a sophisticated web tool that patients use more than 67,000 times a month. Meg McCabe of Aetna hopes that consumers will soon be able to use their smartphones to enter symptoms, find doctors, compare prices and schedule an appointment.

Such experiments will serve insurers well. If Mr. Obama’s health law stands, millions will soon shop for insurance on new exchanges. The easier the plan is to understand, the more people may pick it. A fully transparent market is years away. But a bit of sunlight is creeping in.

 

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