“Doctor office” by Parker Knight, released on Flickr under the Creative Commons Attribution License
Summary: How do people use our data? Listen: “We recently spent much time trying to find the cost of a fairly routine thyroid ultrasound as we now have a high deductible insurance plan,” said the note to us. “It was extremely frustrating. Even Aetna could not give us expected costs or alternate locations for the test. In fact the Aetna website is out of date as it lists closed facilities and sites no longer in our plan. Using the ClearHealthCosts website (found via WHYY’s Pulse) we were able to drop our cost from $1325. at the local hospital off site radiology lab (the lab could not answer whether the rate was the negotiated rate, nor could Aetna), to $120 w/insurance and $150 cash, no insurance at a lab about 30 minutes away. The lab listed on the ClearHealthCosts website confirmed the costs listed were accurate. … We are convinced that this type of transparent system will be the only way to drive down healthcare costs.”
Summary: “Huge variations exist in the prices of some of the most common medical procedures across state lines, according to a report by major insurers released Wednesday, but some experts say the data is of little use to consumers who rarely know what they owe until the bills arrive,” Jayne O’Donnell writes today in USA Today, quoting liberally from our CEO, Jeanne Pinder. “The insurer-funded Health Care Cost Institute (HCCI) won’t disclose which hospitals or doctors are the high-price culprits and instead are releasing how much states’ average prices differ from national average. California, for example, has average prices that are the same as the U.S. averages for dozens of the most common procedures, including pregnancy ultrasounds and cataract surgery. But Clearhealthcosts.com, which compiles prices in 10 metro areas using data from consumers, doctors and hospitals and its own staff members’ research, finds a huge price disparity within a 100-mile radius of San Francisco for some procedures. The cash price for a lower-back MRI without dye ranges from $475 at the Castro Valley Open MRI to a whopping $6,221 at the University of California, San Francisco at Mt. Zion. Patients pre-paying or paying on the day of service at UCSF, however, get 40% off.” Jayne O’Donnell, USA Today, “Huge health care price differences even within same area, by state.”
Summary: “Her name is passed from one desperate family to another like an amulet,” Eric Boodman writes over at StatNews. “In phone conversations and online chat rooms, she’s mentioned at moments when the devout might call on a patron saint. A baby born with a deformed skull? ‘Call Laurie.’ An impossibly expensive cancer treatment? ‘Call Laurie.’ Laurie Todd isn’t a doctor, or a lawyer, or a hospital chaplain. She’s a 66-year-old former massage therapist. Most of the time, she sounds cheerful and efficient. But if someone tries to pull the wool over her eyes, her voice gets low and a little bit threatening. ‘Do you know what I do for a living? she asks. ‘I’m known as the Insurance Warrior.’ ” Eric Boodman, “Insurance Warrior” helps patients get pricey therapies covered.
Summary: We launched our Florida PriceCheck partnership on Thursday, crowdsourcing health prices with new partners WLRN public radio in Miami and WUSF public radio in Tampa Bay, and their Health News Florida collaboration. In the first two days after launch, our web analytics show that we had visits from the Florida Legislature, the Florida Department of Insurance, the Florida Department of Health, Humana, UnitedHealthCare, Cigna, Aetna, the Blues, and about a dozen Florida hospitals. Also visiting: Carnegie Mellon, Johns Hopkins, the Washington State Attorney General, the Broward County Commission and scads of others. Yay for our great partners, who have deep knowledge and stellar audiences!.
Summary: “We buy health insurance for the promise that the insurance companies will protect us from enormous medical bills. But what happens when they don’t keep that promise?” Dr. David Belk writes over at The Huffington Post. “We all know that medical costs are a nightmare for the uninsured. Hospitals and other health care providers mark up medical bills to many times what they expect to get paid, then give insurance companies enormous “discounts” on those bills. Of course if you’re uninsured, you don’t get the insurance “discount.” But what many people don’t know — at least until it’s too late — is that having insurance can sometimes leave you even worse off. Insurance companies can deny claims for any reason, and without warning you in advance. This can leave you stuck with the entire, marked-up bill which you can’t even negotiate. At least the uninsured can negotiate.
Summary: We collect and display cash or self-pay prices — what you would pay without insurance — for about 30-35 common, “shoppable” procedures. Why? To show the range of pricing for simple medical items, which can more or less be compared — as apples to apples. If you see that an MRI can cost $300 one place and $6,000 another place, you’ll be better informed about the health care system, and better able to make money decisions relating to health care.
Summary: When people travel from their own country or their own city to another for care, it’s called medical tourism. How much is there? Depends on who you talk to, and how you define it. “Mexico is already the world’s second-biggest medical tourism destination (behind Thailand), generating $3 billion in 2014. Mexican agencies expect that with increased investment, the country could grow medical tourism revenues to $10 billion-$12 billion in the next seven to eight years. Oil-rich countries in the Middle East, notably the UAE and Saudi Arabia, view better health care provision – including medical tourism – as a way to diversify their economies,” according to a 2016 Deloitte study. Some U.S. destinations, including Las Vegas, have sought to develop a medical tourism industry. Here’s a look at Central Florida’s attempt to become a destination. Here’s a slightly dated roundup on international medical providers. Also, a number of big-name hospitals — M.D. Anderson and Memorial Sloan-Kettering, for example — actively pursue patients from overseas, but real figures are hard to find.
Gavin St. Ours/Flickr/Creative Commons Attribution License
Summary: Why would health care providers want to publicize prices? Of course, you could also ask why they wouldn’t — why we have made a system that keeps patients in the dark about prices until that dreaded bill comes. When we were featured in a Wall Street Journal article by Melinda Beck about providers accepting cash payments that are lower than their chargemaster (or sticker) prices, the comment stream featured a thoughtful reader named Bill Willis. Willis and I struck up a conversation. He is a retired health care consultant and a former hospital executive with a perspective on the marketplace that we don’t often hear. So I asked him to write about the topic. We have seen a lot of providers starting to list prices, but it’s still the exception, not the rule. Willis starts by saying “It may be difficult in some cases, impossible in some, but doable in others to convince providers to disclose their pricing.”
Summary: A shift in the way hospitals collect bills has been taking place for some time, and is picking up speed. “Hospitals and providers, historically, received 90% of the reimbursement from insurers, according to The Advisory Board. The patient portion was more of an afterthought,” writes Holly Fletcher at The Tennessean. “That dynamic is shifting as more people come under high deductible health plans. The ratio could settle around 70-30 — with patients paying nearly a third of their bills, said Ken Kubisty, senior vice president at Advisory Board Consulting and Management. For every patient dollar being billed, hospitals have historically failed to collect 65 cents.” Almost a quarter of Americans have a deductible of $2,000, meaning that they pay out of pocket until that $2,000 level. So: What we’re seeing is that hospitals and other providers, in reaction to these trends, are establishing and accepting cash rates that may be lower than their negotiated or reimbursed rates, and yet allow them to get some money — even if not all of what they want. The landscape is changing daily, as hospitals and other providers look at their bottom lines, and try to figure out what’s next. For patients: Always ask “How much will that cost? How much will that cost me? How much will it cost if I pay cash?” Read Fletcher’s entire piece here.
Summary: “If you’ve had a mammogram or plan to get one, you may not have given much thought to where you should go. We hope to help you understand your choices by beginning a conversation about how to measure quality in mammography,” Martha Bebinger writes at CommonHealth at WBUR public radio in Boston. “Our data collection is not the definitive answer. But many women are surprised by the fact that where you get a mammogram can make a difference in your health. “I was never told anything about that. I don’t think it’s out there,” says Kennedy, who’s come to the Beth Israel Deaconess Medical Center clinic in Lexington for a routine screening mammogram. We collected information on five quality measures from a dozen hospitals that were willing to discuss how they perform when it comes to mammography. In addition to the table above, we have a detailed explanation of the project and the quality measures, as well as what each hospital is paid by one insurer for the test.” Martha Bebinger, Eva Gets A Mammogram: A Primer On Finding Quality In Mammography, CommonHealth, WBUR public radio.