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Posts made in March 2013

Health Care Price Transparency, We Need It Now!

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Can you imagine shopping for food, clothing, home furnishings, automobiles, electronics, insurance policies, and other big-ticket items without knowing the cost you are going to incur? That is exactly what happens in health care. The lack of price transparency in health care and the fact that health care institutions have notoriously charged pretty much what they want for identical medical procedures in similar geographic markets (sometimes as much as a three-to-six fold difference) is common practice. Health care consumers have rarely stopped to consider how outrageous this is.

 

In my last blog post I talked about how to choose the right doctor. One of the critical factors in making these choices, particularly when choosing specialists or hospitals, is to look at charges for certain procedures, and determine whether the charges and quality of care of a specific physician or institution meet your expectations and your budget.Unfortunately, this information is not readily available which makes it difficult to intelligently determine who to use and what approach would provide the best care at the most cost-effective price.

 

The Commonwealth of Massachusetts passed legislation in 2012, Chapter 224 of the Acts of 2012 which attempts to contain rising healthcare expenditures and provide more transparency in health care costs. The law outlines  new requirements and responsibilities for providers, payers and state agencies,  including a mandate that all MA health plans are required to set up a website and a toll-free number where consumers can access provider-specific estimates of costs for procedures or admission to the hospital. This is a good start for the residents of MA and provides a model for the rest of the country.  But it is only a start.

 

Part of the problem with price transparency is that consumers need to know not only the “retail”price for a specific service: e.g. a CT scan, MRI, x-Ray or cardiac catheterization or stent, but also what the institution will charge for performing these tests and what portion of the cost health insurance will cover.  This is not readily available information.

 

Even when you have price information, there is no correlation to quality of care. You can generally assume that the institution, clinic or group charging the lowest price is not providing highest quality of care. The MA regulation coupled price with quality information from healthcare agencies, enabling consumers to figure out where they might find a high value provider. But typically this information is very hard to find. Although Medicare has a website which compares hospitals across the country and rates them on several quality criteria, pricing data is not yet included in the information they have released.

 

As health care consumers we have always accepted the treatments our doctors suggest rather than insisting on shared, collaborative decision-making. Although we talk a lot about the high  cost of our health care we are not behaving as intelligent consumers. We accept the cost of care as a given without ever thinking about shopping around as we would for items that are much less important to our well-being. It is time that we start scrutinizing the cost and the quality of our health care. If we make enough noise about this collectively,perhaps our voices will be heard and the pressure we exert in the aggregate could have an impact.

 

 

 

How to Find the Right Doctor for YOU

 

Collaborative teams, care coordination, shared decision-making, patient engagement, patient-centered care – these terms all imply an interactive trusting relationship between doctors and patients. However  if you do not have the right doctor, someone you can talk with, question, depend on for information resources to help explain your health issues, and be there for you when you have a problem, none of this works.

 

How do you find the doctor who is right for you? The most common way that most people find their special doc is by asking their friends, co-workers, neighbors and family for a recommendation. However, those personal recommendations often do not  work. Therefore you have to embark on a mission –quite similar to the steps you would take to find a home decorator, wedding planner, lawyer or accountant: research, interview, first encounter, evaluation, decision.

 

When looking for a doctor there is specific information that you will want to know:

1. What is the doctor’s specialty and does that match your health issues? You can check out the doctor’s certification status with the http://www.abms.org/or at healthgrades http://www.healthgrades.com/

 

2. What is the doctor’s background i.e. what medical school did he/she attend and where did he/she train after medical school?

 

3.Has this physician passed the required medical boards (that information, as well as information on whether the doctor has ever faced any sort of disciplinary action can be found by contacting your state medical board.

 

4.Does this doctor accept your medical insurance? (Check with your insurer and they should be able to provide you with a list)

 

5.  Is the doctor conveniently located near your home or work? Does he/she have evening or weekend hours?

 

7. How long has this doctor been practicing this medical specialty? Has he/she published any papers? Is he/she involved with any medical organizations?

 

8. Is the doctor in a solo or group practice?  You will probably have a better experience in a group practice where there is 24/7 coverage, and where the group has invested in technology including electronic health records.

 

For primary care doctors, many of these answers can be found at the American Board of Internal Medicine, http://www.abim.org/, or  the  American Board of Family Medicine, https://www.theabfm.org/diplomate/index.aspxe.

 

Other factors to consider are whether or not this doctor has evening or weekend hours or whether the office will schedule same day appointments for urgent care. There are web resources to help you find information on doctors, including the following:

 

http://www.medicare.gov/find-a-doctor/provider-search.aspx

 

www.healthgrades.com**(**easiest to navigate and quickly find the information you need.)

 

www.ratemds.com

 

www.amadoctorfinder.com

 

www.angieslist/doctors.com

 

Your doctor is someone with whom you want to have a long-term relationship so it is definitely permissible to request an introductory phone call. An individual who refuses to do this might not be the right person for you. Some of the personal questions you need answered before making your choice:

 

1. Are you choosing a primary care physician or a specialist? The criteria are different.

 

2. Do gender, language, racial differences matter to you?

 

3. Will the doctor communicate with you between office visits and about treatment options and choices?

 

4. What hospital is the doctor affiliated with and is it a place where you would be comfortable if you had to go there? You can check unbiased hospitals ratings through consumer reports http://www.consumerreports.org/health/doctors-hospitals/hospital-ratings.htm, from the Leapfrog Group, http://www.leapfroggroup.org/ a voluntary program focused on quality and safety issues in health care.

 

Other sites for checking hospitals include:

 

http://www.ewg.org/skindeep/http://www.leapfroggroup.org/cp,

 

U.S. News and World Report annual survey. http://health.usnews.com/best-hospitals/rankings

 

There is nothing more comforting than to know that when you have a serious health issue you have a great medical team that will take good care of you.  Putting in the effort and time to find the right doctor who is willing to work with you to insure that you will have the best possible outcome will pay off in spades.