Medicare releases price comparison data in preparation for the health reform roll-out.

On May 8th, the federal government released in-depth Medicare provider charge data for the 100 most common inpatient procedures for hospitals across all 50 states. Available for the first time, the information highlights the extreme price inconsistencies that patients are charged for the exact same procedure, in the same neighborhood. This recently published government data demonstrates the need for better health care transparency and exposes the disparity that exists between providers in the same area for the exact same service. Patients (consumers) need to understand the true prices they pay for health care services, and be able to determine the quality metrics on providers so they can make an informed decision about the best value – before visiting their provider.

The HHS statement regarding the data can be found here, and a full list of prices can be found on the Centers for Medicare & Medicaid Services (CMS) website.

Prescription drug costs have long been a source of mystery and confusion for both patients and doctors. Consider these points:

• According to a recent survey, almost 50% of patients were too embarrassed to bring up the cost of prescription drugs with their doctor
• Another recent study found that less than one-quarter of doctors actually know the prices of the drugs they were prescribing
• The vast majority of Americans have no idea that prescription drug prices vary significantly between pharmacies

No wonder we’re all confused!

The good news is that the mystery of prescription drug prices is being addressed by GoodRx, a new website and iPhone/Android app. GoodRx has collected over 1 billion prescription drug prices, discounts and savings tips. Consumers need to know that the price for the exact same drug can vary by $100 or more depending on the pharmacy you visit, or what discounts/coupons you use. In addition, there are numerous other ways to save, if you know how.

So what are some things you can do to bring your prescription costs down?

1) Comparison shop
Many people don't realize that prescription drug prices aren't regulated, and some stores offer a far better deal than others. Costco and Sam's Club often have great prices, for example, and you don't need to be a member to use their pharmacies. Even if you're using a coupon, some chain and local pharmacies can charge twice as much for the same drug—take a look at anastrozole, a breast cancer medication, which could cost from $15 to $30 depending on your choice of pharmacy.

2) Go Generic
If your prescription has a generic available and you're still taking the brand, you could save hundreds by switching. Some drugs with recently released generics include:
Propecia
Maxalt
Duetact
Singulair

Generics are approved by the FDA as safe equivalents to brand name drugs, meaning they have the same amount of the same active ingredient and the same clinical effect.

3) Filling a Brand? Consider Manufacturer Coupons.
If your brand name prescription doesn't have a generic available, there may be a coupon or copay card from the manufacturer to offset the cost. They can offer anything from a free trial or $10 off to a card that will reduce your total cost from over $100 to $4 per month, like the one for blood pressure med Diovan.

4) Use discount generic programs
Many major pharmacy and grocery chains offer discount plans for popular, inexpensive generics. Even insured consumers can save versus their co-pay. The most common pricing is $4 for a 30-day supply and $10 for a 90-day supply, lower than most insurance premiums. For a very common drug like lisinopril for blood pressure, you should have lots of choices at under $5 per month. Watch for programs that require a yearly fee—they can still be worth it, but know the terms before signing up.

5) Split your pills
You could cut your lisinopril cost further to around $2 per month by asking your doctor to prescribe you a higher dose and splitting the pill. Always check with your doctor and pharmacist before pill splitting though; it's only safe with certain types of tablets.

6) Take advantage of free generics
Those discount generic programs sometimes include free prenatal vitamins, common antibiotics like amoxicillin, diabetes meds like metformin, and even cholesterol meds like atorvastatin, the new generic for Lipitor. Publix, Price Chopper, Wegmans, and Meijer are some pharmacies that offer free medications.

GoodRx pulls all of this information and more together in one place to give you a tool to let you make better choices when filling your prescriptions.  

Steven Brill’s TIME article, “Bitter Pill: Why Medical Bills Are Killing Us,” is a must read for every stakeholder in our health care system. This 36-page article is the most thorough reporting on healthcare costs that explains why bills are so high. This article is an eye opener on how our health-care system is plagued by warped incentives, overtreatment, poor quality of care and administrative waste. Steven Brill does an excellent job exposing overcharging for services and describing the complete lack of transparency in our healthcare system.

You need to be an educated consumer of your healthcare. Taking control and educating yourself regarding your healthcare will enable you to make better choices about your health and wellness, and save you money along the way. 

A recent article by Jackque Wilson, 4 Ways to Control Your Health Care Costs, provides some excellent consumer advice on how you can control health care costs.   This article is a must read if you have a high deductible, pay cash for services, use out-of-network providers, or have no health insurance.

Here are some highlights from this article:

• People often overpay for services just because they are not aware that you can get the exact same care at a different facility across the street for a fraction of the cost.  Do your research.
  
• Find out up front if the doctor or facility is in your insurance network. Using out-of-network services and providers can cost twice as much.
• Befriend your local pharmacist.  Take advantage of chatting with your pharmacist on a regular basis about your medication management.  Your pharmacist can also recommend generic alternatives
• Make sure you understand your health insurance plan.  Read the small print to make sure you understand what services are included, copays and out-of-pocket cost before you visit your provider
• Take advantage of websites that can help you lower your costs by letting you know what you should be paying for specific services.
  

Fair questions to ask your doctor:

• Tell your doctor up front if you are concerned about price and ask your doctor to help you save money
  
• Ask up front how much a procedure or service is going to cost
• Ask up front if a test the provider ordered is necessary
• Inquire if there is a cheaper alternative or generic version of the medication your doctor prescribed

There are a number of websites you should become familiar with.  These sites are free and can help you lower your health care costs by letting you know what you should be paying for services.

• HealthcareBlueBook – provides "fair" prices for medical procedures in your zipcode.  This site is a free price comparison website for consumers/patients.
  

• GoodRx.com – rated by Consumer Reports as the best application for find the lowest drug prices in store and online.  The site also shows generic alternatives and posts coupons, if available, to help you save money.

Increasingly, patients are bearing a greater and greater portion of their healthcare costs -- whether that be in the form of a higher deductible where they're paying the first several thousand dollars a year of their healthcare expenses or with larger co-pays and higher premiums or simply because they have chosen not get insurance because it's too expensive and they're paying in cash.

Some of the biggest frustrations on the patient end have to do with the difficulty of seeing what you'll be paying until well after the service is rendered, making it very difficult to be able to compare quality and prices to find better value.  And the savings can be HUGE!  Prices can vary as much as 70-80% for the EXACT same service or test.  In today's economy, saving 70-80% on a test that could costs thousands of dollars makes a huge impact on the patient's pocketbook. 

SnapHealth, founded by two ER doctors, is breaking out of the model by offering patients up-front pricing and the ability to compare based on customer service reviews and credentials. Using a familiar web-based interface as you would use to shop for hotels or airplane tickets, patients can quickly and easily purchase the healthcare services they need at significant discounts and know prices upfront.

Doctors and testing facilities can offer these discounts knowing that they won't be refused payment by insurance companies or the government, and that they won't have to pay a billing company to chase after payment.

Launched in Houston, TX, SnapHealth will be opening in several other markets soon.

Take control of your healthcare and your pocketbook today!  After all, it's your health and your money.

David Wong, MD, CEO Snaphealth

There is a really big question in health care, one that could shift the entire industry toward more patient-focused care while simultaneously driving down health care costs. Very few people even think about this question. In my experience even fewer, if any, of those who do ask it are involved in developing health care policy at the federal or state level.

This one question, if deployed, would start to solve the issues facing patients, clinicians, payers, and hospitals – everyone involved in getting or receiving medical care.

What’s the question?

“How much is that?”

There are two things in play in the health care industry that fly in the face of marketplace sense. First is the lack of price transparency. Imagine going to the grocery store and seeing aisles upon aisles of food … without any prices posted.

“How much is that package of chicken breasts?” “That depends. How are you paying for it?”

My guess is that you wouldn’t shop in that market again. Health care is the only consumer-facing industry in the U.S. that doesn’t have price transparency. Worse, if you ask for pricing, you’re often met with blank stares and “I have no idea” as the answer.

Second is how the prices are set. You’ve heard of the medical billing codes – the Holy Codes that state Medicare and health insurance reimbursement payments for everything from lab tests to joint replacement. The price values for each of those billing codes is set by an American Medical Association (AMA) committee called the RUC: the Specialty Society Relative Value Scale Update Committee. This group meets behind closed doors, creates the pricing list for every single medical procedure, and then publishes it. This is not price fixing, since they hand the list to the Centers for Medicare and Medicaid Services (CMS) for publication, the AMA does not publish the list on its own.

Here’s a critical health policy issue: create price transparency. Require providers to know, and share, the cost of the services they provide to the customers they serve: THE PATIENTS. Doing this will accomplish what all the health care blue-ribbon committees and working groups in DC haven’t been able to pull off: downward pressure on health care costs.

Whether you love Obamacare or not, you know that the health care system in the U.S. must change, for the health of our families and communities as well as the financial health of our national economy.

As an example of the results that a health care consumer can get by asking “how much is that?” I offer you a story off the business pages of the Los Angeles Times. One woman discovered that the cash price for the medical procedure she needed was $1,054, but only after her insurer had been billed $6,707, of which her co-pay was $2,336. If she’d asked “how much is that?” she would have saved herself $1,282. That’s a hard lesson, isn’t it?

How broken is the health care payment model in the U.S.? It’s pretty darn broken, as evidenced by that anecdote alone. By asking for pricing information when making health care purchases, we can have a positive impact on our own financial outlook while simultaneously opening up new communication channels with our health care teams. Their work has value. That value, and its pricing, should be transparent to us. We’re paying the bill: through insurance premiums and co-pays, health savings accounts, self-pay for health care, or a combination of all three.

So the next time you’re buying health care services, ask that really important question: “How much is that?” If you don’t get an answer, consider shopping in another health care store.

That will start bending the cost curve!

Disruptive Women in Healthcare

Written by:  Casey Quinlan on October 24, 2012

Casey Quinlan is a digital health activist and author of "Cancer for Christmas: Making the Most of a Daunting Gift". She speaks frequently to both clinician and patient audiences about the power of participatory medicine and data-sharing, and is an advocate for price transparency in healthcare.

This time of year millions of consumers are encouraged to get the flu shot.  According to the CDC (Centers for Disease Control and Prevention), everyone who is at least 6 months of age should get a flu vaccine this season. It’s especially important for some people to get vaccinated.  Those people include the following: people who are at high risk of developing serious complications like pneumonia if they get sick with the flu, people who have medical conditions including asthma, diabetes and chronic lung disease, pregnant woman and people who are 65+.

If you don’t have health insurance, or if your health insurance does not cover the flu shot, it helps to know how to shop around to find the best value.  Many people pay out of pocket for a flu shot and prices for this vaccination can range from $15 to more than $50 if you include the cost of an office visit.

In terms of quality, safety and effectiveness, there is no difference between immunizations at a store clinic or a doctor s office. It’s perfectly safe, says Jim Turner, the executive director for the Department of Student Health at the University of Virginia and a past president of the American College Health Association.  They are buying the same vaccine doctors’ offices buy.  Retailer clinics must also follow state regulations on administering vaccines.L NAME

Even for consumers who get their shots free with insurance coverage, it still pays to shop around for the best flu shot promotions because some of them are far more generous than others. 

Here’s a sampling of flu shot prices and promotions and where consumers can get flu shots.

FastMed Urgent Care -   $15. FastMed has several locations in the Triangle, including Apex, Cary, Raleigh, Chapel Hill, Durham, Holly Springs, Fuquay-Varina and Wake Forest.

Harris Teeter -  $24.95. Through Dec. 31, customers getting flu shots receive coupons for $5 in free groceries. The coupon is good through Jan. 7. And, if you’re a new Harris Teeter pharmacy customer, you’ll receive a $20 grocery credit loaded to your loyalty card.

Kroger -   $25. A recently expired coupon on their website shaved $15 off the price but these digital coupon offers are frequently reissued so it’s well worth checking.

Rite Aid -   $29.99. Customers receive coupon booklets with savings valued at $100 and 25 Wellness+ points that can be applied toward future shopping perks.

Wake County Human Services -   $30. However, the shots are free to many groups of people, including uninsured pregnant women, family members and caregivers of infants under six months of age, students attending any college or university in North Carolina, and children who qualify for the federal government’s Vaccines for Children Program. Weekly clinics are held at the Public Health Center at 10 Sunnybrook Road in Raleigh. Additional clinics are scheduled throughout the county. Go to wakegov.com/humanservices for more information.

CVS -  $31.99. Customers getting flu shots receive 20 percent savings passes valid on regular-price merchandise.

Walgreens  -  $31.99.  Special promotion offered through Oct. 31, customers getting flu shots receive 1,500 Balance Points, which is equal to a $1.50 credit in Walgreens’ new loyalty card program.

Corporations - Corporations often offer their employees flu shots. Business would rather keep employees at work rather than out sick, so offering a flu shot can be a cost saver. Costs range from free to being covered by insurance. Employers often pay an administration fee to have the shots given. Cash payments usually range between $20 and $30.

Doctor's offices - Many often flu shots are given in your local doctor's office. If you have insurance, you will make a co-payment for your appointment. Seasonal flu shots are covered by most insurance policies. If paying cash, a doctor's visit can cost $20 to $200, plus the cost of the shot, which can be $20 to $30.

Retail outlets - Big-box retailers or retail pharmacies also offer flu shots in the early fall. Walmart, Target, Walgreens, Rite Aid Pharmacy and CVS/Pharmacy all offer clinics at certain dates that are subject to change and vary according to location. Check the stores' individual websites for times and locations. Insurance covers the seasonal flu. Cash payments range from $20 to $40.

Senior Facilities - In many communities, local departments of public health offer flu shots to senior citizens. People 65 and older make up 90 percent of deaths from the flu, so health officials often ask seniors to get vaccinated. Medicare Part B covers the cost of a seasonal flu shot for seniors.

Public Facilities - Sometimes flu shots are offered in public locations such as libraries or YMCAs or other public-access facilities in order to reach large segments of the community. These are often sponsored by a local charity or by a public health outlet and usually take cash payments to cover the cost of the shot.

Schools, Colleges and Universities - Colleges and universities often ask students, staff and teachers to get vaccinated. Students in particular often share living spaces and can easily infect one another. Many colleges and universities require students to carry insurance, which will cover the cost of the flu shot.

More consumers are using the Internet to comparison shop for health care services, according to a new survey.

You shop for purses online, new glasses or sometimes even your groceries. And now, many people are looking for medical services in the same place.

In fact, according to a recent survey by insurance giant UnitedHealthcare, 14 percent of respondents reported using online resources to compare and shop for health care treatments and services.

While that's in contrast to the more than 75 percent who said they use the Internet to shop and compare things like cars and electronics, it does indicate that consumers are moving into Internet health care pricing, UnitedHealthcare found.

In response, UnitedHealthcare is making big improvements to their myHealthcare Cost Estimator, which is an online service that helps consumers find services and compare costs. The new estimator includes mobile versions and the ability to compare quality and cost for more than 574,900 different health care providers and 4,275 hospitals.

But United isn't alone, and many of its competitors are right here in Nashville. MDSave, MedSolutions, Healthcare Blue Book and Change Healthcare, all based in the Nashville area, have services aimed at price transparency.

More Consumers Using the Internet to Comparison Shop for Health Care
By Annie Johnson
Staff Reporter
Nashville Business Journal

By Sara McFarland

Patients are learning that they are the ones with the power when it comes to health care decisions. Due to trends towards value-based purchasing, a new level of clinical standards has been set. These standards have opened the doors for pricing transparency and the opportunity for patients to become more knowledgeable of what they are truly paying for in the health care world.

The decision to go to one physician or another lies in the hands of three game-changing, delineating measurement points; the Patient Experience, Pricing Transparency and the Culture of Care. These three elements nod to the groundwork of what health care should represent, a focus on physicians building relationships with every patient, every time. Websites like Save On Medical help patients to take these aspects of their care into account when they are looking for quality providers.

Doctors in every sector of health care are looking for better ways to connect with new patients and are speaking in hushed tones about the concept of self-pay, which used to mean higher costs and more complications for both patients and physicians. Until now, there was never a way for both patients and providers to benefit in cash pay situations. This new era in Health Care Reform and pricing transparency means an opportunity for physicians to target patients, insured or uninsured, in reference to personalized, affordable service and quality care, while also allowing patients to make their own educated care decisions.

By focusing on the following items, patients can feel confident that no matter their coverage, they are getting the best care at fair prices:

1. Demand price transparency and turn to transparency tools online
2. Compare competing facilities’ quality and take into account things like; convenience, technology, physician involvement and patient reviews
3. Negotiate pricing when possible
4. Understand that high costs do not always mean better care and bigger does not always mean better.

Many patients are unaware of the vast price difference for procedures such as MRI or CT scans at large health care providers versus independent outpatient imaging centers. It is hard to determine the difference in quality of care when there is no price transparency. Fortunately, Save On Medical provides tools to compare quality and prices at competing practices, helping them to choose the provider that meets their needs in regards to price, convenience and quality. Explore your options as a patient and you can be sure of the value of your care.

Sara McFarland serves as the Communications Specialist for Atlantic Health Solutions and Save On Medical, leading the companies' social media, public relations and blogging efforts. Her writing has been shared on a number of industry websites and trade publications such as Health Imaging Magazine and Imaging Economics.