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Decoding health care prices

October 10, 2015

Tags: price transparency, health prices, medical charges, medical bill, hospital price, price disparities

by Pat McNees (updated 9-28-17, 9-14-17; original post 10-10-15 was Taking the mystery out of health care prices)
Can we lift the veil on health care prices? Are we moving toward pricing transparency (getting doctors, patients, service providers, and insurance companies on the same page)? When our doctors send us for tests and procedures, must we be like the dinner guest in a fancy restaurant who is handed the menu without prices? How many of us know up front what a colonoscopy costs -- or how much charges for any procedure vary from one clinic or doctor to another? What does an MRI cost? Are prices uniform or predictable?

Until recently, it has been difficult to know in advance what a particular health problem or procedure will end up costing us, as patients. Or how much health care costs vary between practices, cities, and states. Some things are changing, but you have to do your homework to be a smart health care consumer. The following articles shed light on a changing system and improvements in which information consumers have access to.
In Health Care, A Good Price (Or Any Price) Is Hard To Find (Jenny Gold, Reporter's Notebook, KHN, 9-14-17)A recent story about why Northern California is the most expensive place in the country to have a baby began as a tip from an obstetrician. Dr. Sarah Azad told me that insurers were paying her just a third of what they pay doctors employed by large hospital systems in her town of Mountain View, Calif. "As it turns out, the vast majority of contracts between doctors or hospitals and insurance companies are subject to a gag clause, which prohibits either party from disclosing negotiated rates. That means it’s almost impossible for consumers, researchers or journalists to find actual, accurate numbers, despite the fact that cost differentials among doctors can be so stark.... I have long understood that the lack of price transparency is one reason our system stays so expensive. It was a surprise, though, to find out that this opacity is cemented by legally binding contracts....It’s no accident that data on physician costs are so hard to find. Its inaccessibility allows hospitals to keep raising their prices. It’s simply not in their interest for the public to know how much they’re charging. And insurers don’t want other doctors or hospitals to see the high prices they’ve agreed to pay, for fear they would demand the same....In the end, all of us — through our insurance premiums and our taxes — pay a price for non-transparency."
Clear Health Costs: Cracking the Code Coverage. In April 2017, New Orleans PriceCheck, reporting on and crowdsourcing health prices with partners WVUE FOX 8 Live and NOLA.com/The Times-Picayune, began saving its readers and listeners lots of money by comparing health care prices publicly. Says Jeanne Pinder, "We use shoe-leather journalism, data journalism and crowdsourcing to reveal the mysteries of pricing. The project is on fire, with hundreds of people sharing their stories, commenting, and sending in their EOB's [explanations of benefits]. The hospitals are extremely upset with us, and we have been able to save people hundreds of dollars (more…)

End-of-life planning and decision-making
Have "The Conversation"

October 9, 2015

Tags: Compassionate choices, Choosing Wisely, slow medicine, death with dignity

by Pat McNees
Resources for when terminal or life-threatening illness requires decisions about what individuals, families, and professional caregivers should do. Let's start with
Five Wishes (Aging with Dignity -- changing the way we talk about and plan for care at the end of life). Five Wishes lets your family and doctors know:
---Who you want to make health care decisions for you when you can't make them.
---The kind of medical treatment you want or don't want.
---How comfortable you want to be.
---How you want people to treat you.
---What you want your loved ones to know. (more…)