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Let's Talk Cost
from Let’s Talk Cost 2012
in What’s Your Idea?
January 29, 2012
Posted by LetsTalkCost on behalf of Chantel J.:
Chantel J. suggests that hospitals “should give every patient an estimate cost of care before they leave the hospital or while making the appointment.” Do you have an idea to help improve transparency?
Heidi M. commented on February 1, 2012
That is a great idea -- we get estimates for car repairs and etc, so why not our health costs. The only one I can seem to get them from now is my dentist.
Let's Talk Cost commented on February 3, 2012
Heidi, do you think your doctors could easily adopt how your dentist provides estimates? What other information would help you make better decisions about the quality and cost of your health care?
bill s. commented on February 14, 2012
estimates are a good idea.
Bethany H. commented on February 15, 2012
When I had my daughter, the hospital was able to provide me with an estimate for both a natural delivery and C-section. However, when I had a different surgery the following year I was told no information was available. The fact that they had it for childbirth and collected up front leads me to believe they can get estimates for any procedure but choose not to.
Let's Talk Cost commented on February 17, 2012
Thanks for sharing your story Bethany. We’ve begun to work on this issue by providing cost estimates through our Find a Doctor search. You can read more about what we’re doing here: http://connect.bcbsnc.com/lets-talk-cost/cost-transparency/
If you are a BCBSNC customer, we invite you to try out Find a Doctor search here: http://www.bcbsnc.com/content/campaigns/mycost/index.htm?cmpid=mycost
What other information would help you make better decisions about your health care?
Susan B. commented on March 17, 2012
Not only should patients receive an estimate of cost of care, as a nurse, I know outcomes are important, not just cost. Example, how well does a hospital treat a problem, complication and deaths rates, etc.
Let's Talk Cost commented on March 21, 2012
Thanks Susan, we agree that cost and quality go hand-in-hand. What is the most important way we can work together to lower medical costs while improving quality of care?
Susan B. commented on April 3, 2012
I agree there are too many variables to consider to accurately estimate costs up front. One person, for example, may need an additional blood test, x-ray or MRI and the costs could be significantly more.
I am not sure how aware the public is of hospitals being selected for Magnet designation, Chest Pain Center Certified and Stroke Center Certified. Hospitals with these certifications have proven track records of better care. Magnet hospitals generally have more educated nurses (higher levels of BSN, some all BSN and Master prepared nurses). These nurses have more experience, training and are therefore more able to pick up on subtle changes in patient conditions that many times can prevent further complications for patients (which translates into lower costs and lower complication rates). Certification for chest pain and stroke treatment are hard to obtain, meaning a hospital has to meet specific requirements and timelines in order to be certified. One example - a patient having a stroke or chest pain would immediately be assessed and treated rather than having to wait and risk further complications (which means more costs). The emergency room, cardiac cath lab and cardiac operating room are always standing by ready for patients, no delays (no delays by doctors, nurses, etc.). I worked on a hospital committee for Chest Pain Center accreditation and our patients received superior care in the initial treatment of chest pain. Most patients went from ambulance (home) to cath lab with a diagnosis in 30 minutes or less. I would encourage BCBS to look at what it takes for a hospital to be certified, how it has affected the hospitals treatment of patients and if complication rates were lowered. Reward those facilities that do a better job.
Let's Talk Cost commented on April 8, 2012
Thanks a lot for your suggestion, Susan. BCBSNC is highly focused on rewarding quality heath care, so we appreciate your comments on this front. It sounds like our efforts with Blue Distinction Centers may be similar to what you have outlined. We look forward to hearing any other comments or suggestions.
Barbara T. commented on March 23, 2012
I agree that it should be more clear cut as to what you will spend BEFORE going in. The current system is so confusing that it intimidates most people and discourages them from asking questions. Then if/when we do ask questions most of the answers from the employees are " I really don't know--I can check that for you" then when they get back with you on an answer it's not much of an answer at all. Most have come back to me with vague replies and possibilities of what the charges are for, but nothing concrete. They usually blame the doctor or procedure because it's not written down anywhere in any clear cut fashion because this way it is left open to "interpretation so the "powers that be" have an opening to them to charge more if they feel the need, for something they hadn't anticipated.
Michele L. commented on March 30, 2012
So a mom goes in the hospital to have a baby- winds up in intensive care--- or needs an emergency C- Section or the baby has issues.... There are things that are unknown that raise the cost. Do people going into a hospital really only want the care that they agree to in advance--- And then what happens when the price is higher-- besides the reputation of the hospital being marred for offering standard of care treatment as required by the patient's need. Sorry to say there are too many variables to know what a hospital stay will ultimately cost-- bare bottom price barring ANY complications- possible but will that price be realistic?
This is an opening for an insurance company to say we will pay x amount of $$$ for a certain procedure, the hospital gets to divide it up-- I imagine anyone reading this will show how care will diminish with that school of thought.
Let's Talk Cost commented on April 3, 2012
Thanks for your comment, Michele. You bring up a great point. We agree that quality of care should not be sacrificed to improve cost transparency. The cost estimates we provide are a ball park estimate for many common procedures. Previously, patients have been left in the dark on this information and did not have access to cost data prior to having a procedure or treatment. As you point out, we cannot guarantee the price of a procedure because there are too many variables to consider, including complications. Even so, providing cost estimates is a step in the right direction. We want our customers to have as much information as possible so they can make more informed decisions about their care. How can we work together to provide cost information while improving quality?
Michele L. commented on April 3, 2012
Hi Community Admin-
I guess I would feel a bit better better about Blue's wanting to provide estimates if they educated their members with what a basic charge is and some situations that could make the cost go up.
You didn't mention my concern...This is an opening for an insurance company to say we will pay x amount of $$$ for a certain procedure, the hospital gets to divide it up-- I imagine anyone reading this will show how care will diminish with that school of thought.
****Please address ***You say that person should have an idea of what a procedure should cost, but if you listen to the message recording on BCBSNC they say that just because you are told something by a representative that it does not mean that it will ultimately be covered-- How is that transparent?
Personally I have a cadillac small business plan that went up 30% last July- I take Health Care very seriously for my family so I am concerned that though I am willing to sacrifice to have the best that the new models (one cost covers all idea) will consider all treatments to be equal. Different meds treating the same illness may have different side effects and have different prices- cheapest is not always the same, the same goes for an artificial knee.... (Sort of like saying a handbag is a handbag whether it is a Kmart brand or Chanel)
Thanks for writing back, Michele. You have hit the nail on the head, and bring up a new payment model we have started to introduce called “flat-fee care” or also known as “bundled payments”. In our flat-fee care model, we work with doctors to determine up-front cost calculations that are developed specifically with the individual patient in mind – taking into consideration the likelihood of complications and other impacting factors. Those cost estimates are not only tailored to the patient, but also encourage collaboration between the various physicians. With this model, research has shown that quality of care actually increases. What do you think about this approach?
To address your other question about the message you hear on our phone line, this is intended to be transparent about our services. Because we can’t predict how a doctor or hospital will submit a claim or code a procedure, we can’t guarantee coverage before a doctor’s visit. This actually goes hand in hand with providing cost estimates, and not being able to guarantee a price due to the variables we’ve discussed. Hope that makes sense. We know it’s complicated.
Michele L. commented on April 4, 2012
I am not thrilled with paying a lot of health care -BUT- I'd rather have the opportunity to benefit for 2012 technology. But that does cost money- so I would rather cut other places than my family's healthcare.
Studies published by diMasi et al. in 2003, report an average pre-tax, capitalized cost of approximately $800 million to bring a new drug from the study to market.
Tuition does not include books, lab fees, etc. In 2010-2011 the median total cost of one year's attendance iat medical school was $49,298 and $66,984 for public and private universities, respectively.
Patients choose hospitals that have the most up to date equipment. There is a lot of equally expensive equipment needed to meet standard of care. Without it litigation would be rampant and who would choose a hospital without resources. An example to consider--MRI machines can range in cost between $1 and $3 million. Construction of MRI suites can easily add another $500,000 to the total cost. An extremity MRI machine alone costs $300,000 or more, and can only be used to scan hands, feet and knees. Purchasing a used-extremity MRI scanner can cost as much as $150,000.
Personally I'd rather take a 5 day Zpack than 2 weeks , 3 times per day amoxycillian- I am concerned that this new cost cutting will offer patients whatever the lowest bid will buy. Or one rate for an entire procedure- for the hospital to divide up-- will encourage fitting in more patients and therefor losing quality-
I showed the expenses because we to have to be reasonable that things need to be paid for and school loans need to be paid.
Michele L. commented on April 8, 2012
I'm really not opposed to everything but I am not a fan of flat fees. Call me a sceptic but I get the feeling that BCBS is planning on lower their costs, but I am not hearing anything about how that will affect my insurance rates. Already Docs and hospitals must work together to heal a patient and have the added motivation of being constantly under the litigation microscope- I don't see how see how treating them as a collective society rather than an individual encourages them. I am not a physician but I choose to be paid for my job efforts and not based on a group that I do not control.
As for the BCBS message- I am not asking if BCBS can say how much something will be covered for- I have a deductible which is suseptable to real time changes but I do know that I pay 10%. BCBS has their contracts pay to a portion of the regular billable amount and I realize that I am responsible for the balance- I am saying that BCBS will not even say if a procedure is covered- even with the code.
My experience with needing an antiflammatory and BCBS not ALLOWING my doc to prescribe celebrex so I am stuck with a generic that caused me to to have my feet swell up- now I was told to try another generic and maybe that would work better, if not we will try something else--, I already knew because of samples that the celebrex works with no reaction-- But the price is more (even though I would be paying $35 rather than $10) so I cannot get it-- ***That is what I see as the future of BC/BS new cost cutting measures and it concerns me-- Is BCBS trying to tweek their own budget to lower the premium price-- or just lower the price of approved products, availablity and quality of what they pay for?- It appears that they are saying the docs and hospitals should work together and earn less while BCBS maintains their profit margin.
As BC/BS cuts all of their expenses Do they plan on lowering the prices of their premiums in the future- have they ever?
Dr. John Fong commented on April 11, 2012
Senior Medical Director, BCBSNC
Michele, we appreciate your taking the time to air your concerns. We welcome everyone’s ideas and opinions, even when they may not be the same as ours. We have roughly 4,000 employees who make decisions about their own health care and their families, so these are questions we have found ourselves asking as well. So I can assure you that we do not want to reduce quality in the name of cost. In fact, we have found in our efforts that when quality increases, costs go down (such as reducing complications or return hospital visits). These are the areas we want to focus on. You bring up a good point about generics, and this is an area we’re seeing reduce spending trends as the cost of branded and specialty medications continue to increase. The use of generics is an important discussion one should have with a physician. But there is evidence that use of generics has helped off-set rising drug costs, so they are an important factor.
As we’ve discussed on Let’s Talk Cost, rate increases are parallel with health care trends and utilization. The goal of our efforts we are putting forth to rein in costs is to ultimately slow the rise in health care spending, which can impact premiums. While this may take some time, I am optimistic that we can make an impact in North Carolina while supporting and improving quality health care for our members. One example I would ask you to consider, this past year we had a rate increase of zero for the Blue Options HSA and Blue Saver plans. I’d say that is encouraging.
FS E. commented on June 12, 2012
I think that should be available, though it may keep some peopel from getting surgery, ect, if they have no coverage. Look I had hernia repair 2 1/2 years ago and Dr said it would be outpatient. I ended up having to stay for 5 days. He told my regular Dr "She seemed like she was in a lot of pain" to the tune of $16,000+. I had another hernia last month repaired same Dr same hospital outpatient. 5 hours & went home. So far it is $12,500. WHY??!!??