Uberize My Medical Care, Please

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My doctor replied, “Don’t worry about cost. Insurance pays for it.”

I responded, “Not exactly. First, I have a deductible that I haven’t satisfied, so I’ll be paying. Second, insurers don’t pay claims. Insurers write checks. My employer and I pay for all services, whether directly through my deducible or next year through premium increases.”

William G. (Bill) Stuart

Director of Strategy and Compliance

October 17, 2019

I’ve hailed exactly one cab during the last four years of business travel – and that was a fluke. Otherwise, I use uber. I love the convenience of uber. When I need a ride on a rainy day from my hotel to Capitol Hill, from the airport home to pick up another vehicle when my car wouldn’t start and my daughter’s nurse pinning was less than three hours away – I use uber. Never a cab.

Why? Let me count the reasons.

First, uber informs me up front of my options, the price and whether I’ll share the car with other riders – so I’m never surprised. I can choose which option – solo or ride-share – I want, factoring in variables like price and arrival time. I can compare the uber price to the price of a ticket on an airport shuttle bus. All prices are transparent, allowing me to shop for the best deal as I balance my wallet and my time.

Second, I can look up my uber driver on the app before I enter the car. Other riders rate him, so I know what to expect. If I see any negative reviews, I can factor those into whether or not I want to accept the offer of a ride. I have no such information about cab drivers (although some taxi companies are implementing uber-like software to provide more information to riders).

Third, I can push a button on the app and tell someone in whose car I’m riding. This feature gives me comfort knowing that, if something terrible happens, the police will have a lead.

Fourth, I can track my route using a map on the app. I can see my pick-up and drop-off points and make sure we’re heading in the general direction rather than reenacting a horror movie.

In short, I have all the information that I need to make an educated decision about what type of care to receive and where to receive it.

The Medical Iron Curtain

Now contrast that experience with my current medical needs. I need to undergo diagnostic CT and bone scans to determine whether my partially disabling lower back issue is due to the extruded disc that was diagnosed last year or sensitivity at the nearby joint. The treatments are different, so it’s important to isolate the source of pain, stiffness, and inflexibility.

My insurer has a price tool. It’s buried about three layers deep in my online portal. I need to log in, scroll way down to “Tools & Resources,” and scroll down again to “Estimate My Cost.” Then I have to read an explanation and click on “Go to Estimate My Cost.” How much lower would Amazon’s revenues be if customers had to go to those lengths to find the price of a product?

When I look up a CT scan of the lower back, I see that every one of the seven providers in my geographic area charges the same price. That can’t be right. I have to look closer than the bold $254 cost jumping out at me to realize that figure is the remainder of my deductible, so I pay the same amount out-of-pocket at each location. But the provider’s price (the tool uses the term cost, but a provider’s prices and a provider’s costs are two very different concepts) is listed in much smaller type.

I now have the information that I need to make an informed decision. The hospital where my doctor is based actually offers the service for about $150 less (about 20% less) than its fellow Harvard University teaching hospital. And they’re both equally inconvenient. If you had a choice of two identical Disney family vacations, would you choose the one that cost $5,080 or the one that cost $3,640?

Then I looked up the cost of a bone scan of the lower spine. Dead end. When I search for bone scan or spinal bone scan, the closest I find is a Bone Scan (Full Body). That sounds like a very different procedure. The rest of the services listed include bone-density scans, full body and regional PET scans, and various CT scans. The tool provides no meaningful direction. Most of these scans are priced at $619 to $758. One is listed at $1,358. That’s the price of a bone scan at a cancer hospital, so that may be a very different test.

Am I to assume that the pricing of full body scans parallels pricing for lower-back body scans and that the facility offering the $619 price has the lowest price for my actual diagnostic test? I don’t know.

Would I chance an uber ride if I had a party of six, including a mobility-impaired relative, and received quotes of ranging from $6.19 to $7.58 without knowing whether the vehicle was a Triumph Spitfire (two seater) or a Suburban?

I don’t have that dilemma with uber, because it asks me about any special needs (like group size and disability), and only a driver who can meet my needs responds to the request. But I am absolutely lost when it comes to determining the right location for my bone scan. I simply can’t find that information.

Should I Care about Price?

When my doctor ordered the CT and bone scans, he asked me which was the nearest hospital to me. When I told him, he said, “We can schedule the tests there for your convenience.” I found that statement interesting, since I (and probably you) have been bullied by doctors to receive advanced imaging at their facility because “we get the results faster” or “the images are clearer” or “we know and trust the quality of the product.”

I told him that my local hospital was one of the most expensive in the state (a fact that I knew from my two decades for an insurer frustrated by the local hospital’s bargaining power). My doctor replied, “Don’t worry about cost. Insurance pays for it.”

I responded, “Not exactly. First, I have a deductible that I haven’t satisfied, so I’ll be paying. Second, insurers don’t pay claims. Insurers write checks. My employer and I pay for all services, whether directly through my deducible or next year through premium increases.”

So, yes, I care about price. That’s why I’m really trying – and struggling – to find the right location to receive care. I understand that price and quality are unrelated in medical care, unlike a cut of steak or an automobile. I don’t want to waste my own or my employer’s money by receiving what I consider a commodity service (my list includes imaging, colonoscopies, immunizations, lab tests, routine screenings, and diagnosing simple conditions like strep throat, ear infections, and rashes) at an expensive site when I can receive the same outcome for as much as 80% less.

Who Can Help?

Where can patients turn to find more information about prices?

Providers. Providers know the prices that they’ve negotiated with insurers for specific services. But patients’ attempts to find this information often break down when the patient says “CT scan of the lower back” and the hospital asks the patient for the Current Procedural Terminology (CPT®) code for the service. Medical prices are tied to these codes. Unless the patient knows the CPT® code for the service, the conversation typically doesn’t go far.

Insurers. Insurers have this information as well – organized by CPT® code also. Insurers often have some form of “transparency tool” to help patients find price information, but those tools are often buried (as in my case) and don’t’ always reflect current costs. But when you find a price, it should be specific to your plan (negotiated prices often vary on specific products, like an HMO and a PPO) and be fairly accurate.

State governments. Some states maintain a data base of medical prices and quality measures for consumers. New Hampshire is among the leaders. These data bases provide some good directional information to patients. Unfortunately, the data are usually market averages, rather than insurer-specific prices. A patient can identify which hospitals appear to have higher and lower prices for the same service, but they can’t determine their actual cost or whether their insurer’s prices are consistent with – or buck – the overall trend.

Private parties.  A growing number of companies are trying to fill this information void by offering employers some creative and effective solutions for a monthly fee. Two companies with which I’m familiar in New Hampshire are instructive because they offer real, actionable price information.

One company with which I’m familiar offers a concierge service. If my doctor orders a bone scan at a particular hospital, I call the company. The nurse reviews my insurer’s cost data (supplied by a regular claims file, so the data are current) and identifies lower-price options. If I choose a lower-price option, she schedules the appointment and processes all paperwork. Employers usually give employees a reward – often a gift card of between $50 and $150 – when the claim at the lower-price facility is processed.

A second company also has claims information sorted by insurers. It offers a downloadable app. When the doctor tells a patient that he needs a bone scan, he can ask her for the CPT code as he pulls out my phone and opens the app. He quickly see all his options within a geographic area that he defines. Doctor and patient can then have a very interesting – and for the doctor, usually eye-opening – conversation.

The Bottom Line

Because patients don’t pay directly for medical care – as they do for car tires, groceries, or a mattress – they’re largely insensitive to cost. They have a financial incentive to manage their direct out-of-pocket costs, but far too often they lack tools to become informed consumers, stop caring once they’ve satisfied their deductible or out-of-pocket maximum, choose convenience over cost, or simply follow their doctor’s every recommendation.

That’s a major reason why medical care is so expensive – because prices don’t correlate with quality and consumers, for myriad reasons, don’t buy based on price and quality. Lifting the iron curtain on prices won’t solve that problem entirely, but it will give the growing number of patients with higher out-of-pocket responsibility the information that they need to become as prudent in their medical purchases as they are when they spend their own money directly on all other items that they purchase.

What We’re Reading

What do women really want? Forbes columnist Eric Brotman won’t wade too deeply into that topic, but he shares some thoughts by Jean Chatzky on how women and men take different paths toward retirement. The common denominator: Both men and women can benefit from planning for medical expenses in retirement by opening and contributing to a Health Savings Account during their working years. Read his column here.

Too few people understand the basic benefits of a Health Savings Account, according to many consumer surveys. Recent polling by Bank of America shows four areas of widespread misunderstanding. Read more here.

Opponents of the Affordable Care Act have argued that when out-of-pocket costs are unaffordable, the concept of coverage is largely meaningless to a person who needs care. Drew Altman of Kaiser Family Foundation sees a similar barrier to care in employer-based coverage as well. Read his column here.

 

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