One hospital wants to have the 'cost talk' with patients

There are two questions every patient should ask: What's wrong with me? And what's it going to cost me?

Most people ask the first; very few the second.

But with insurance plans requiring higher out-of-pocket expenditures from patients, the cost talk is increasingly becoming a major discussion point between patients and providers.

Now one hospital is tackling its "price list" head on. Here's Tim Birkenstock, CFO for Miami Children's Hospital, recently speaking to NPR:

"[The price list is] very misleading … It is the equivalent of the sticker price on a car, or some other starting point for a conversation. But it certainly doesn't represent the answer to the question most of our families want to know, and that's: What's this going to cost me?"

In fact, the hospital is cutting all of its "prices" by 30 percent. It issued this news release on January 14, 2014:

Miami Children's Hospital has reduced its charges by 30 percent and begun a process of developing packaged pricing for some high-volume services as the first phase of an initiative aimed at enhancing consumer understanding of hospital fees and what patients actually pay for services. 

Others have already begun to address cost, especially in the wake of Time magazine's March 2013 omnibus cover story "Bitter Pill," which exposed major issues with costs, charges and reimbursements. 

Surgery Center of Oklahoma last year went a step further and began publishing its prices, although if you have insurance the price will be different because it was already negotiated by your insurance company.

Miami Children's should be applauded for this bold move. Making cost a critical part of the conversation is an important move toward actually tackling escalating health care costs.

Tackling the high cost of health care (with Tedy Bruschi)

Tedy Bruschi knows a few things about tackling. Now he's hoping to help Shields MRI tackle the high cost of health care.

If there were any doubt that the health care cost battle is being taken to the public, just watch the 30-second TV spot currently running from Shields Health Care Group featuring their pitchman Bruschi, the former and much beloved New England Patriots linebacker.

Tedy Bruschi can tackle, no question. Tedy talks about tackling the high cost of health care by choosing Shield Health Care Group MRI for the highest value. Shields Health Care Group is the largest independent imaging provider and has the largest network of independent radiation oncology centers in New England.

It's a well-written and very direct ad that touches on some critical points in the health care cost debate.

I'm Tedy Bruschi. Tackling a professional football player is not easy.  But tackling the high cost of health care, now that's easy.

Just go where I go — Shields MRI. 

The Shields family gives you a quality MRI at a sensible price. In fact, they could save you up to $1,000 or more. 

So get out there and take on those high medical costs. It's easier than taking on a really big fullback. Trust me."

A key phrase is "sensible price" followed by a very specific dollar figure — "up to $1,000 or more" — almost like a Geico ad.

In fact, Shields backs it up on its website with a chart comparing its cost for an MRI ($563) to the state average ($693) as well as the average for an MRI at community hospitals ($743) and teaching hospitals ($1,153). The page has a link to an MRI cost savings calculator and tips about how to "talk cost with the doctor."

Of course Bruschi has the last word in the ad:

"Why overpay for an MRI? Choose to go where I go — Shields MRI."

It would be great to see how Shields measures the ad and whether people do really exercise choice in selecting high-cost services, such as imaging. 

As patients become more cost-conscious consumers, especially as more people are enrolled in plans with high deductibles and out-of-pocket costs, these direct-to-consumer pitches will surely resonate.

Is your visit to the "ER" driving up health care costs?

In Houston, your closest Emergency Room is pretty darn close.

It's part of a hot national trend of building freestanding ERs. They are more convenient and usually speedier than the traditional ER that is attached to a hospital. They also cost more.

Houston already has a bunch, according to a recent piece in Kaiser Heath News (KHN).

Nowhere is the trend hotter than in the Houston metropolitan area, with 41 freestanding ERs and 10 more under development. Counting the freestanding ERs and traditional hospital-based ERs, greater Houston has 150 emergency rooms — twice the number as Greater Miami — even though its population is only slightly bigger, according to a KHN analysis.

These facilities are often co-owned by physicians and are "often located near high-end shopping centers, … target consumers with private insurance [and] bill like regular emergency rooms." 

The KHN piece analyzes the costs to the health care system associated with these new facilities. They can "charge insurers double or triple the amount per patient as an urgent care center or doctor's office." Some patients are using them for routine care that would cost less in their physician's office.

Why?

Insurers have little power to stop patients from using the facilities because by state law, they must pay for ER coverage anytime a patient perceives they have an emergency, regardless of whether that turns out to be the case. For that reason, the freestanding ERs have no need to contract with insurers and offer discounts.

The main reason they are more costly than urgent care is that they charge a "facility fee" on top of a fee for the physician's time—just like traditional ERs. The facility fee was originally intended as a way to help hospitals recoup overhead costs including 24-hour staffing, administration and equipment. 

Price and cost are considerations every health care consumer will sooner or later need to address. 

If the Affordable Care Act is going to make care, well, "affordable," health systems and physicians will need to be more assertive in educating patients about using the right facility at the right time to receive the right care.

That way, everyone can win.

Original source: Columbia Journalism Review

Medical care is intended to help people …

There's no denying health care is big business. But the big payoff should be focused on patients.

In a July 4 op-ed in the New York Times, H. Gilbert Welch, MD, MPH, professor of medicine at Dartmouth's Geisel School of Medicine and an author on health care ethics, posited whether health care's current business model borders on "criminal."

"Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufacturers — are the ones benefiting."

Dr. Welch points to recent media coverage, such as Time magazine's 36-page cover story "Bitter Pill" (March 4, 2013), that shows pricing disparities and how consolidation has increased costs, notably to those who can least afford to pay them.

One area of concern is the acquisition of physician practices by hospitals and health systems. Is this motivated by money (hospital-owned physician practices get higher reimbursements) or achieving the Triple Aim (higher quality, lower cost and better patient experience)?

Probably both.

There are growing examples that show the acquisition of physician practices by hospitals has resulted in more tests and higher costs (Dr. Welch gives a few examples). There is also plenty of promise of better coordinated medical care through disease management and improved patient engagement.

But what is clearly evident — especially in areas where "integrated" health systems are truly integrated (think Kaiser Permanente) — is that care can improve when everyone is working collaboratively toward the patient's well-being.

Dr. Welch had another poignant line:

"… what happened to the word 'community' next to the word 'hospital?'"

By building a truly integrated system — from physicians to hospitals to community wellness programs — we can again focus on improving the health and well-being of our communities and reserve the medical part of the system to take care of those who genuinely need it.

That's accountable care — being accountable to the community you serve and the patients who put their trust in you.