Why We Should Know the Price of Medical Tests. Patients as consumers and shoppers is nonsense‼️

Read the following story and let me have your opinion. I read these types of stories and then look beyond the glowing reports; what are they thinking?

When was the last time a result of 15% of anything was considered a success? If an employer offered a new 401k plan and 15% of employees signed up, who would be jumping for joy? What if only 15% of those eligible signed up for Obamacare? (Perhaps not the best example).

If only 15% of patients offered lower cost services with concierge assistance seek out those services, that’s good?

A $220 saving or 18.7% means the average cost was $1,176.47, a far distance from $300 to $3,000.

The notion that we should be turning patients into consumers is pure nonsense.

What we should be doing (and there is some of this) is focusing on coordination of care and efficiency of care. In other words trying to assure each patient receives the appropriate level of care in the right setting and no more and no less.

If a hospital cannot deliver an outpatient service on a competitive basis, there should not be referrals to that facility rather than asking the patient to shop for the best deal. Look at the last two sentences below. We promote conversion to electronic medical records, but if that is done within a hospital or physician practice and is not integrated with other providers there is very limited value. We can’t effectively coordinate care, we can’t avoid duplication of unnecessary procedures.

But here is the real reason so-called consumerism does not work to control health care costs. Health care spending is not evenly distributed. Five percent of the population consumes 50% of health care spending. Fifteen percent of the population spends nothing on health care in a given years. The sickest and most expensive patients are over 65 and in the last 18 months of life; hardly candidates to go shopping for the best deal in health care. The average person can shop all they want for that occasional MRI; it’s not going to impact rising health care spending.

The insurer WellPoint provided members who had scheduled an appointment for an elective magnetic resonance imaging test with a list of other scanners in their area that could do the test at a lower price. The alternative providers had been vetted for quality, and patients were asked if they wanted help rescheduling the test somewhere that delivered “better value.”

Fifteen percent of patients agreed to change their test to a cheaper center. “We shined a light on costs,” said Dr. Sam Nussbaum, WellPoint’s chief medical officer. “We acted as a concierge and engaged consumers giving them information about cost and quality.”

The program resulted in a $220 cost reduction (18.7 percent) per test over the course of two years, said Andrea DeVries, the director of payer and provider research at HealthCore, a subsidiary of WellPoint, which conducted the study. It compared the costs of scanning people in the WellPoint program with those of people in plans that did not offer such services.

Better still, Dr. Nussbaum said, the exercise in price transparency had a ripple effect: Hospitals in areas with the program lowered their prices too, because “they were beginning to lose patient referrals.”

Tests like M.R.I.s show some of the widest price variation in American medicine, studies show, often varying by a factor of 10 even in the same city. Hospital scanners tend to charge the highest prices, a practice that in part reflects higher overhead but also reflects hospitals’ power in a market. Physicians affiliated with a hospital often refer to the hospital’s radiology department. In some cases, this is because hospitals require them to do so; in others, it is a matter of familiarity and convenience because the results will turn up more rapidly on their office computers.

After two years of the price transparency program, price variation between hospital and nonhospital facilities was reduced by 30 percent in areas where it was implemented, the Health Affairs study found.

The study also suggests that patients are more vigilant custodians of cost than their doctors. Several years ago, WellPoint gave physicians similar price information on scanning providers in their practice area but did not see a change in referral patterns, Dr. Nussbaum said.

The newer study did not delve into patient motivations. Some patients probably chose the cheaper scans because their insurance plan required a 20 percent copay, so it made a huge different if the scan was billed at $300 or $3,000. But others had probably already met their annual out-of-pocket maximum, so choosing the cheaper site was merely a matter of principle, Dr. DeVries said.

From experience, I can say that shopping for scans is not always easy. When I learned the price a hospital was charging for an M.R.I. a neurologist had recommended for one of my children, I scheduled the test at an outside center that was two-thirds cheaper. The upside was much better value for my health care dollar.

The downside: The hospital and the radiology center would not communicate with each other, though they could have easily done so electronically. I had to go to the center and pick up a disk with the scan and carry it to the hospital neurologist.

via Why We Should Know the Price of Medical Tests – NYTimes.com.