Healthcare Shopping and the Quest for Information

There are articles and websites devoted to helping people decide on everything from cribs to caskets.

US News and World Report ranks colleges and Consumer Reports measures car safety.

The information to help consumers shop can be nearly overwhelming.

But say you want to find a great deal on knee surgery?

Fisher: Currently, the state of information that’s available to consumers is woefully inadequate.

That’s Elliot Fisher, a professor at Dartmouth Medical School.

Fisher: There’s recently been a little bit of information about the quality of providers, but it is sparse. And the information on the cost of care is also extremely limited.

Fisher adds that it is information about these two factors—cost and quality—that is necessary to make consumers out of patients.

Information is starting to trickle out to the public.

A few months ago The New Hampshire Hospital Association launched a website cataloguing the average charges for common procedures at all the state’s hospitals.

For example, you can find that the average charge for having a Caesarian section at Parkland Medical Center in Derry is about two thousand dollars more than the state average.

And at Southern New Hampshire Medical Center, it’s about fifteen hundred dollars cheaper than the state average.

Looking at these charges might give a patient a sense of the average price tag on a procedure, but there’s one major limitation: charges are not the same as payments.

Kathy Bizarro is the executive vice president at the New Hampshire Hospital Association.

Bizarro: Someone who might have a high deductible plan, they’re probably doing that through an insurance company and that insurance company might already have a discount arrangement through the hospital. And the person with that plan with benefit from that discount.

So even though Parkland might charge ten thousand dollars for a C-section, private insurers—through their discounts—might get a bill for only 60 percent of that charge.

Here, the state’s insurance department website comes in handy.

It lists the average payments by private insurance for common procedures—from doctors visits, to MRIs, to major surgery.

But neither of these websites get to what is probably most important regarding price: how much does the patient actually have to pay?

Just last month Dartmouth Hitchcock Medical Center installed the out-of-pocket-estimator on its website.

Mary Kay Boudewyns, vice president of revenue management for the Medical Center, says the estimator uses the average charge sent to insurance companies.

—and figures out what the patient is actually going to pay.

Boudewyns: We do ask patients to estimate what’s your deductible, do you have a co-payment for this type of service, do you have an out of pocket maximum? They provide us with that information and the system calculates, applies those considerations to whatever the charge is, to refine what the patient would have to pay.

Boudewyns says that for people with high deductible plans, the estimator is pretty useful.

But again, the calculator uses charges, and does not incorporate the specific discounts each insurance company might have.

The estimator might find an MRI at Dartmouth Hitchcock will max out your deductible, but if your insurance has a discount, it could save you some money.

But by law, insurers and hospitals can’t divulge negotiated prices to the public.

Even if exact prices were available, some patients might not be concerned with where they can get a bargain on knee surgery.

They’re more interested in where they can get the best knee surgery.

Websites with names like leap frog and health grades provide quality ratings on hospitals and doctors.

But Rachel Rowe from the Foundation for Healthy Communities advises patients to be wary.

Rowe: Healthgrades is largely a black box. We don’t understand their methodology very well at all.

Rowe says there aren’t many reliable resources available that compare quality among providers.

Rowe: And that’s actually very difficult to do, because of small numbers, because of risk adjustment.

The key measure of quality is how well a patient does, but that depends on how sick the patient was to begin with.

Accounting for these differences is difficult.

But Rowe says there is some information about good care.

The Foundation for Health Communities runs a website that displays how well hospitals adhere to certain medical practices, like giving aspirin to patients who come in with a heart attack.

But even these measures, Rowe adds, are not a good proxy for the quality of a hospital as a whole, and she doesn’t recommend the website as a way for patients to shop for healthcare quality.

However, Rowe says there is one nugget of information that could help.

Both the Foundation’s website and the Hospital Association’s price website contain the number of times a hospital performs a certain procedure.

Rowe: We in NH feel that that could be a mark of quality for some folks. Some people might not want to go to a hospital that only treated three, five, or eight with congestive heart failure. And we feel that that’s important for consumers to understand about hospitals.

Rowe says New Hampshire is the only state that offers these data.

With the modicum of information that’s available to healthcare shoppers, where does that leave consumer driven healthcare?

Vailas: Better than it was last year though.

Nick Vailas is the president of Patriot Healthcare.

Vailas: We all need to understand this is the very beginning. Without question this is going to take time. It is a step in the right direction.

It is also a crucial step: without information available to patients, Vailas says, consumer driven healthcare will not work.

The government is stepping in to expedite data getting to the public.

The insurance department plans to post on its website information that will get a lot closer to the patient’s bottom line.

Not only will is list prices for procedures, but they will specific to each insurance company, says Leslie Ludtke, the Department’s Healthcare Policy Analyst.

Ludtke: For example if you know you need knee replacement, you could put knee replacement in and you know you’re covered by Anthem, you could put Anthem in. And then you can look at what the different providers would be paid by Anthem for that service.

Accompanying this information will be how many times each provider performs the procedure, and an out-of-pocket calculator.

Ludtke expects these specifics to come on line toward the end of the year.

And many organizations involved in healthcare transparency say more information will emerge in the coming years.

But the ultimate question remains: if more data become available, will people use them to make decisions?

For NHPR News, this is Kerry Grens.