We can all give Kathleen Sebelius and Steven Brill big high fives and hugs for the price transparency revolution they’ve helped start. Last week the government released the pricing at various hospitals for the 100 most common procedures. This revelation has proven the pricing gap and variances between hospitals, even in the same cities, and made it become more widely known and publicized to the patient population that they should be price shopping.
This data dump of hospital charges comes from a master list called the “chargemaster,” which we explained in a post last month. For uninsured patients, this information is significantly helpful. Unfortunately for patients with insurance, these numbers can only serve as an estimate, as private insurance companies determine separate rates through the hospitals. We are proud to see that Medicare is aiming to increase price transparency and give patients better access to tools to make smarter decisions.
A main concern of most journalists seems to be that while the prices are being shown, this data does nothing to provide information on quality.
In an article from The Washington Post, it was written, “Patients might assume, as they do in shopping for cars or houses, that the more expensive hospital will provide superior care.” We know that quality and cost are not directly related when it comes to the healthcare industry, especially when you take into account hospital owned clinics versus independent providers. Patients of course do not want to make the wrong decision when it comes to the care, which is why they usually trust their family doctors with most referral decisions. We are able to provide quality grades alongside the pricing for the radiology procedures listed on Save On Medical, which helps patients make smarter decisions, but it is clear that quality will be harder to distinguish at hospitals and hospital owned practices.
Regardless, this unveiling contributes significantly to the path paving that Steven Brill and The Catalyst for Payment Reform have lain down for transparency. It is becoming more and more apparent that we are catching the healthcare consumerism wave at the right time.
As price transparency trends call attention to hospitals and physician’s offices to display the costs of their services, we’ve learned some new hot topic terms and seen behind the curtain to learn some of hospitals’ greatest self-pay secrets. This can be blamed in large part to Steven Brill’s Time article “Bitter Pill: Why Medical Bills Are Killing Us,” which due to its impressively widespread distribution, has influenced a whole new market of patients to explore the world of health care costs.
The main challenge patients say they face is that there is nowhere to go to find accurate aggregates for pricing. Come to find out, since 2006 the California Office of Statewide Health Planning & Development has been requiring hospitals to submit a list of their average costs along with the costs of 25 other common procedures. This list with the mythical costs everyone says do not exist, is called a chargemaster, also referred to as the Charge Description Master.
This comprehensive list of procedures with their billable costs for patients and insurance providers includes services, procedures, fees, supplies and anything that could incur costs during the time, which a patient is at a hospital. These costs vary significantly from hospital to hospital, and often times they don’t even know where all of the costs come from lending understanding to the price gaps that exist. The list price is designed to give patients with good insurance coverage breaks on cost, consequently transferring the full list cost to uninsured patients and those paying out-of-pocket for services who are unluckily and usually the more price conscious patients.
An article by Hal Stern, the CEO of Financial Health, discussed the biggest mistakes that hospitals and providers can make with self-pay, mostly pointing to the need for more avenues and payment options or improved patient relations. Now we can add chargemasters to that list, often leading hospitals to out-price their care for uninsured patients since Mr. Brill unearthed their best kept secret from patient-consumers.
With hospitals charging any where from $1,000 to $2,000 for diagnostic imaging services like MRIs for uninsured patients, patients are forced to look elsewhere for affordable pricing or risk their health by forgoing necessary procedures. Thank goodness for the rise in quality and cost transparency, and websites that help patients see that they can in fact get the care that they deserve if they aren’t afraid of doing a little comparison shopping.
An article in the Tampa Bay Times this week by Jodie Tillman, discussed how patients in Tampa are able to curb high health care costs by shopping around for lower prices. The need for price and quality transparency in our country has been answered by sites like SaveOnMedical.com and other websites like Healthcarebluebook.com. The rise in patient consumerism and patients taking an active role in researching their care proves the need for website like Save On Medical, especially for patients searching for affordable radiology services when the bills end up being so high.
Read Tillman’s article in full below:
Sunday, April 14, 2013 4:30am
ST. PETERSBURG — Cory Rider was pulling a paddleboard off a high shelf when something else came down instead: a heavy piece of electronic equipment that struck his collarbone before falling to the floor.
His neck and shoulder swelled and hurt, but Rider, 31, tried to wait out the pain. He has neither health insurance nor extra money for imaging to assess the damage.
“I had no idea how much these things cost,” said Rider, who owns a paddleboard business called NinjaFit.
No wonder. Patients are routinely urged to help curb health care costs by being good comparison shoppers. But getting straight answers about the cost of medical services is a struggle.
Prices depend in part on who’s footing the bill. Providers can get more from private insurance than from Medicaid or Medicare, and bill accordingly. And the uninsured, who have no government or corporation to protect them, get socked with the biggest bills.
And even in a single provider’s network, prices can be all over the map. Need a colonoscopy? In Tampa Bay, in one insurance plan’s network, the price tag is anywhere from $600 to $2,400, according to an analysis by the health care software firm Castlight Health. How about a chest X-ray? Prices in the same network are $17 to $536. A mammogram is $14 to $295.
But patients who once shrugged off the discrepancies as their insurers’ problem no longer have that luxury. Gone are the days when insured patients were responsible only for a small co-pay. Many have moved to high-deductible plans that require them to pay much more out of their own pockets in exchange for more affordable premiums.
But that hasn’t made prices any more transparent.
“Who knows what the actual cost of service is?” said Nancy Metcalfe, senior program editor at Consumer Reports. “They’re asking people to be price sensitive and they can’t find the price.”
That may be changing. States are looking at making medical prices more visible. Consumers can use websites to check prices among providers willing to play along. Even medical advertising — still largely silent on price — is changing. Walgreens is promoting its inexpensive new primary care services. Online coupons offer rock-bottom prices for services from cosmetic procedures to dentistry to chiropractic.
When his collarbone pain didn’t go away, Rider went to an online search engine, typed in “cheap MRIs,” and landed on a Tampa-based website called Save on Medical. He found discounted cash prices for dozens of area imaging centers, including Rose Radiology and SDI Diagnostic Imaging. He signed up for a $75 X-ray, a cheaper image, offered by a Pinellas facility, and learned, to his relief, that his collarbone was not broken.
Save on Medical works like a travel website, allowing users to lock in the cheapest prices and book appointments online. The imaging centers, which pay to advertise discounted cash prices, benefit by not having to hassle insurers for payments — or losing money on no-show appointments. Most of the site’s users have no insurance, though a growing number — currently about one-third — have high-deductible insurance plans and find the site’s prices cheaper than their insurers’ negotiated amounts, said Matt Schneider, the site’s 32-year-old co-founder.
“Before, your physician would tell you where to go and you’d follow them blindly,” Schneider said. “You can see there’s a shift in people taking matters into their own hands.”
Florida got a D on a price transparency report card released last month by an employer group, Catalyst for Payment Reform, and the nonprofit Health Care Incentives Improvement Institute. Not impressive, but better than the F’s that 29 other states got.
The state has taken some small steps toward making prices more obvious. In 2011, for instance, lawmakers required urgent care clinics to post cash prices of their 50 most frequently provided services. But the state still got poor marks on the report card for failing to make prices at hospitals and other providers more readily available to the public.
This month, Walgreens became the first retail chain to expand its in-house clinics — usually the place for minor emergencies like sinus infections — to include diagnosing and treating chronic conditions such as asthma and diabetes. And prices are posted: Diagnostic exams start at $79 for self-pay patients — people who aren’t using insurance.
More than 300 of its Take Care Clinics, including those in the Tampa Bay area, employ nurse practitioners and physician assistants who can write prescriptions and order tests. Most insurance plans are accepted.
Dr. Alan London, chief medical officer for the clinics, said its cash prices are lower than most offered in the community. “Affordability is a hallmark of our business,” he said.
When you buy paper towels or milk, it’s easy to shop by price, because you know exactly what you’re getting. But how do you know if your bargain MRI or teeth cleaning is as good as the higher-priced options? Or might you even find that the lower-priced option is more to your liking?
There are websites that purport to rate physicians and hospitals, but their criteria can be squishy. “Patient satisfaction” can be measured by time spent waiting to see the doctor — not necessarily whether you received the best standard of care. That’s tough for people not trained in medicine to judge.
Dr. Peter Ubel, a physician and behavioral scientist at Duke University, wrote in the Atlanticmagazine this month that focusing on prices may backfire. Patients don’t shop for health care the way they shop for toasters, he noted. Many assume, sometimes wrongly, the most expensive service is the best. “We need to stop naively assuming that price transparency will function in health care the same way it does in other parts of the economy,” he said. “What works for toasters won’t necessarily work for MRIs.”
Castlight Health, one of the pioneers in the price transparency business, sells software to self-insured employers, whose workers can then compare the costs of various health care providers. Senior marketing manager Christine Evans said it’s difficult to get data showing patient outcomes for specific doctors. So Castlight provides information such as the number of a specific surgical procedure a doctor has performed to help clients judge quality.
Schneider, the Save on Medical co-founder, said shopping won’t work for all health care services, certainly not for emergencies. For now, he’s sticking to imaging and other diagnostic testing. The quality of these services can vary depending on the skill of technicians and the quality of the machines. But the procedures are not done on an emergency basis, giving patients time to research the providers. Save on Medical has begun using a “docometer” to rate patient satisfaction.
But when funds are limited, price may be how you choose health care. Ashley Fraigun, a 30-year-old yoga instructor and runner from Tampa, has no health insurance. When her right hip began throbbing after long runs, she tried to nurse the injury on her own. “I was nervous about how much this would cost,” she said.
Finally, she went to a walk-in clinic, where the staff told her she needed an MRI. Fraigun’s brother had just paid $300 for one — more than she could afford — so she went online and found Save on Medical. Like Rider, she got an X-ray for $75. “It’s hard. Rent, all the other life expenses,” she said. “I’m glad there’s some self-pay options.”
Last week, Fraigun got her results. She was told she has hip bursitis and should take ibuprofen and refrain from running for about six weeks — the least expensive treatment plan she could have asked for.
Note: This story has been updated to reflect the following correction: Two customers of Save On Medical, a Web site that advertises prices on imaging services, paid $75 for X-rays. A story Monday reported another type of image.
Here are websites that can be used to compare prices:
As health costs soar, more consumers shop by price 04/14/13 [Last modified: Monday, April 15, 2013 11:12am]
Exercise trends come and go, every craze more unique than the previous one. In the 80s and 90s Jazzercise and aerobic tapes led women in neon leggings and sweatbands to fitness routines that could double as dance moves to Whitney Houston’s newest hits. As years went by work-out-fiends worked towards Buns of Steel, kicked butt in TaeBo, danced their ways to weight-loss with Zumba, awkwardly struggled through the Shake-Weight phenomenon, found peace with Yoga and Pilates, right up to the newest, and my personal favorite fitness fad (to watch); MUD RUNS.
(photo courtesy of ToughMudder.com: http://toughmudder.com/wp-content/uploads/2012/12/Tough-Mudder-Florida-2012-Saturday-Gudkov-2730.jpg)
You must overcome a number of physical and mental barriers when you commit to a healthier lifestyle, but that has never been truer and literal, than for those who commit to participating in tough-mudders. Now, I’ve seen some army boot camp movies in my time, and it seems that this workout trend is dangerously similar to the kind of punishment soldiers endure during times of rigorous training, so why someone would elect to participate in such an event is beyond me, but it has caught on like wildfire.
The health care writer in me draws parallels between almost everything I see and issues within the industry, so as I cheered on my friend who was participating in one of these muddy excuses for exercise, I couldn’t help but compare this harrowing process to what many patients face when attempting to navigate themselves through the health care system.
Common obstacles that patients face can range from not having health insurance, not being able to afford high costs and going without necessary care, fear and urgency and ultimately not understanding the perplexing language and nature of health care. Let’s consider the path an uninsured patient in Florida faces for example when she discovers that she tweaked her knee in the tough-mudder she ran in last week.
Polly Patient needs an MRI of her knee to confirm that she has torn her meniscus again. She calls around to a few providers who leave her hanging like someone stuck on the monkey bars while she waits and waits for pricing, getting tug-o-warred back and forth between one hospital’s billing department and one practice’s scheduling office. In cases like these, Bloomberg reported that 20% of patients, regardless of their age, asked their doctors for low cost treatments while 44% of patients will go online to research better options for their care.
The issue is that often times that there is not just one price for a specific procedure, though there could be, as Richard Meyer of The Tampa Bay Times points out. Say that Polly actually gets pricing or decides to just move forward with her appointment regardless of price transparency, she might have to pull herself up a giant hypothetical hill with a muddy rope and army crawl through mud trenches to get an appointment. Getting an MRI can be scary. You’re worried that something could be wrong with you, you’re not used to being at a hospital or doctor’s office and then, they stick you in a giant tube shooting radiation at you. Might as well crawl back into one of those tight-tunnels before the electric cord, spaghetti-hanging segment of the tough-mudder and stay there.
The difference between an experience like this and a positive patient experience comes down to patient education and providers helping those patients to become more conscious of quality, costs and the resources at their disposal. In his article for The Atlantic, Peter Ubel points out that until we create a way for patients to be more conscious of the need to price shop and compare quality, transparency could potentially backfire. Thanks to Jodie Tillman’s article from the patient’s perspective however, it is clear that patients are becoming much more savvy when it comes to consumerism in the health care process.
Price and quality transparency websites and patient resources for education aim to help patient consumers make smarter decisions so that at the end of the rat race, they have overcome the barriers and obstacles they faced and are standing, smiling with a trophy, not getting bopped in the face by a giant red ball… or overwhelming health care bills, if we’re speaking literally.
What navigating yourself through the health care process can feel like: http://www.youtube.com/watch?v=45-W17ZdCS4
Get better. Spend Smarter. Save ON Medical.
Many people complain about healthcare costs and do not even know that price shopping for healthcare services is possible. A recent article that was published in the Wall Street Journal, discussed two employers giving their employees different healthcare plan options, following trends for healthcare consumerism. The companies found that most employees went for the lower-priced plans, which required them to pay more out of pocket for necessary procedures.
In a recent article in Forbes, the writer wrote about direct healthcare providers, which is a new way of receiving your primary care. Access HealthCare in North Carolina has adopted this new system. They charge for an annual comprehensive preventative-screening physical exam, and after patients pay for it, all of their provider visits and most lab work only costs $20. This new concept of care delivery is slowly becoming more and more popular around the country.
Patients have many options to help offset those out-of-pocket medical expenses. There are a ton of insurance comparison websites like ehealthinsurance.com and healthcompare. Some Urgent Care centers show pricing online and of course there is sometimes free clinics, which can be found through the National Association of Free Clinics.
Some of the largest out-of-pocket expenses patients will see are typically for radiology procedures. A good resource for patients to find low cost radiology options is Save On Medical, which acts as a hotels.com for radiology procedures. Patients can save hundreds of dollars by using this site, whether they are insured or uninsured. The typical price of an MRI on Save On Medical is around $400, whereas at a large hospital owned system can run over $1000.
There are also, quite a few options for dental care, which can be a largely self pay industry. Sites like DentalWorks and Gentle Dental, which have a variety of locations throughout the country that offer specials and special financing are valuable resources. 1Dental offers patients the option to get lower cost dental insurance with plans as low as $75/month. CareCredit, which is a credit card program used specifically for healthcare needs offers special financing options and can be used for most medical needs.
If a patient is searching for affordable primary care physicians, they can search through ZocDoc, and specify insurance information or if they will be paying out of pocket for more specific tailored results. However, there is no website for primary care that offers pricing information up front like Save On Medical does for radiology.
With more healthcare options on the horizon, healthcare consumerism has been booming. More and more people are doing their research to find the best prices. In a Huffington Post article, one of the writers even found that if you have a high deductible healthcare plan that it might be cheaper for you to pay out of pocket for certain procedures.
So, do your homework! Find out the best prices and the best options for your care. Take control of your care, be a real patient-consumer.
It seems that our nation is in a tizzy of disappointment over the Catalyst for Payment Reform’s report card on price transparency by state. The country is rightfully tizzying, as it is about time patients gain access to treatment costs and easily understandable health care bills.
The report, which was released on Monday, awarded only 2 states A grades for their transparency, while a whopping 29 states received F’s and a whole 7 states got D’s. The components, which contributed to these grades, included policies being in place to keep patients in the loop as far as the costs of their health care procedures and the scope of costs they will be response for after their visits. The scoring matrix, which they used to grade each state can viewed here:
It was stated that none of the states have implemented full transparency but it is evident that patient consumers want clear access to costs. We can assume this based on the reader feedback to Steven Brill’s article in Time, Bitter Pill: Why Medical Bills are Killing Us, about the nature of health care costs. The main issue is that patients do not see or understand the pricing gap between various procedures and services at different physicians’ offices. Patients can now compare prices online, consider quality and then make their own educated decisions.
We know this isn’t a trend that will pass with the wind either; transparency is here to stay. The Center for Payment Reform has announced that they will be conducting their report annually, handing out state report cards each year, until the states adopt transparency. States adopting these transparency laws is an important step, however it is just as valuable for patients to take control of their own care as it is for providers and payers to pave the way to transparent care.
Stay tuned in the next few days for a video response from our Co-Founder and Vice President, Matt Schneider on the effect this report card will have on patients, transparency and where to go from here.
In light of a recent report stating that over two-thirds of U.S. states have fallen below a D for price transparency, Doshi Diagnostic will be sharing their costs and quality grades for all radiology procedures at their 29 locations online at SaveOnMedical.com.
New York, NY: 3/19/13 – Doshi Diagnostic now will be sharing their radiology costs and quality grades with patients online on Save On Medical. Based on the challenges New York patients face when it comes to price transparency and understanding health care costs, Doshi Diagnostic decided that they needed to become more transparent to improve their patient process.
By searching for radiology procedures on Save On Medical, patients in Manhattan, Brooklyn, Bronx, Flushing, Kew Gardens, Hewlett and Jackson Heights can find discounted prices for diagnostic imaging services as their 29 locations.
In addition to their affordable prices, Doshi Diagnostic also offers high quality care and service. The Docometer Grading Team at Save On Medical has examined the locations and given them scores based on an aggregate of grading principles, giving patients better insight into the components of what makes a practice the best.
Patients can schedule appointments online today at Doshi Diagnostic.
About Save On Medical:
Save On Medical is a website that helps patients find affordable, high quality health care services. With demands for better price transparency; Save On Medical displays the costs of radiology services alongside of reliable quality scores, so that patients can make educated health care decisions.
Florida Radiology imaging centers lists prices on Save On Medical, giving Fort Myers, Florida patients better access to high quality, low cost radiology procedures.
Fort Myers, Florida: Save On Medical now lists costs and quality scores at Florida Radiology’s imaging center locations in Fort Myers, Sanibel and Fort Myers Beach on their price transparency website.Patients can easily schedule appointments with their doctors and pay for their procedure online before their appointment.
The state of Florida is home to 3.8 Million uninsured individuals, a whopping 20% of the population.Lee County is home to a significant number of those individuals, which is why Florida Radiology’s decision to provide self-pay prices on Save On Medical is so beneficial to the community.
The average cost for an Abdominal MRI in Fort Myers is listed as $1,736, however patients who go on Save On Medical can get the same MRI for as low as $400 and book their appointment online.
Patients can schedule appointments at Florida Radiology’s offices on Save On Medical starting today.
- Florida Radiology- Shell Point
- Florida Radiology- South Pointe
- Florida Radiology- Estero Beach
- Florida Radiology- Sanibel
- Florida Radiology- Barkley