Understanding Healthcare Consumerism

Orthopaedic & Spine Center

Physicians see increase in need to educate patients in both the quality and cost of treatments.

NEWPORT NEWS, VA. (November 13, 2013) – More and more, Jeffrey R. Carlson, M.D., Managing Partner with the Orthopaedic & Spine Center (OSC) in Newport News, is having as many monetary conversations with his patients as he is medical.

Patients aren’t just trying to understand how a specific treatment plan will make them feel, but also if they can afford it, said Carlson. They ask about injections versus surgery, for example, and about the financial impact of their choices short term versus long term.

“The decision lies with the patients,” Carlson said. “It’s their lives and their medical issues they have to treat. But we are having those cost discussions and using it as an opportunity to educate patients on how they can make more informed choices in their healthcare.”

Carlson and OSC are not alone in this trend, often referred to as healthcare consumerism.

“Consumerism is a common discussion that we have with our clients, especially since it has become necessary to choose higher deductibles to achieve lower premiums,” said Dayton Wiese, a benefits consultant with Experient Health, the health insurance arm of Virginia Farm Bureau.

Take Anthem Blue Cross Blue Shield’s Cost Comparison tool as an example. Anthem members can review approximate costs for procedures or treatments, evaluate physicians’ quality outcomes and make decisions based on their current benefits plan – all from their personalized account online.

Anthem’s tool “helps (patients) make more informed financial decisions based on costs for procedures/treatments and your out-of-pocket costs for more than 168 common medical procedures and treatments,” according to Anthem.

It also gives a side-by-side comparison of the reimbursement for procedures, which can be translated into the cost to the patient.

“When patients see a bill for a procedure or a test, they see that it costs a certain amount,” Carlson said. “The charge isn’t the issue. The charge can be almost anything because the actual reimbursement is related to the negotiated price that the provider has with the insurance carrier. That’s what Anthem now offers – a glimpse into that negotiated price and the actual reimbursement.”

Wiese has seen more people interested in assessing this data, he said, and has walked many of his clients through Anthem’s tool.

“Patients want to know how much things cost and what they are responsible for,” Carlson said. “In our country, we have been talking about healthcare costs and how to contain costs. This kind of comparison tool is really important because it gives patients more information at a time when we are all more skeptical of costs.”

And it allows them to focus on their treatment, versus how they will pay for it.

The cost to patients and reimbursement differences can be in the range of thousands of dollars.

“Reimbursements for what physicians get paid are fairly similar throughout,” Carlson said. “A knee replacement done by a surgeon in Newport News is going to be the same price for a surgeon in Richmond or North Carolina.”

But for some procedures, Carlson said, “we are seeing a staggering difference in the reimbursement of the procedure itself and the cost to the patient. Take the example of an MRI scan. A hospital two miles away from us is reimbursed at a much higher rate even when our open MRI scanner is brand new and the most powerful open scanner in the area.”

Based on the Anthem Premier policy for a 30-year-old female, the negotiated rate at area hospitals is approximately five times that of what OSC (an orthopaedic medical practice) would be reimbursed for the same procedure.

In the Anthem tool, patients not only see the cost of a procedure, but can also determine where to go to have the procedure done within their geographic area.

Beyond reimbursement rates, Wiese advises his clients to also look at the quality reports in the Anthem Cost Comparison tool, calling it the most important feature

“People will pour over Consumer Reports and online reviews for months before they purchase a new dishwasher but there is a lack of awareness and availability for comprehensive comparisons of medical facilities,” Wiese said.

Carlson agrees.

The other avenue patients can have some influence in their cost of healthcare, Carlson said, is in finding a quality medical provider with a history of quality outcomes.

If patients use “surgeons with a history of higher quality outcomes, there’s a better chance of them having less complications and less problems after surgery.”

Complications could equal return visits, more co-pays and a longer period away from work.
Patients can find out online how many types of procedures have been done by physicians, find health grades and see where hospitals ranks in terms of complications and infections.

The time in research is worth it, Carlson said, because “the quality is where you save the money.”