costs of care


Study: Hard To Shop For Hip Surgery, Even With $100K At Stake

(pasm/ Wikimedia Commons)

(pasm/ Wikimedia Commons)

As WBUR’s Martha Bebinger has reported repeatedly, it is hard, hard, hard to compare the price tags on medical procedures — even though the out-of-pocket costs to you could vary dramatically depending on where you get your care.

Now a new study in the journal JAMA Internal Medicine pins down this shopping problem for one particular procedure: elective hip surgery called total hip arthroplasty, or THA.

The researchers called hospitals around the country — and called and called and called, up to five times each — in search of the institution’s lowest price for a 62-year-old grandmother who lacked health insurance but could pay out of pocket. From the paper’s abstract:

Results Nine top-ranked hospitals (45%) and 10 non–top-ranked hospitals (10%) were able to provide a complete bundled price (P < .001). We were able to obtain a complete price estimate from an additional 3 top-ranked hospitals (15%) and 54 non–top-ranked hospitals (53%) (P = .002) by contacting the hospital and physician separately. The range of complete prices was wide for both top-ranked ($12 500-$105 000) and non–top-ranked hospitals ($11 100-$125 798).

Conclusions and Relevance We found it difficult to obtain price information for THA and observed wide variation in the prices that were quoted. Many health care providers cannot provide reasonable price estimates. Patients seeking elective THA may find considerable price savings through comparison shopping.

Oh, except, wait a minute, you can’t comparison shop very well when more than half of hospitals can’t give you their prices.

The latest health reform law in Massachusetts, passed last year, is supposed to address this problem and require greater price transparency from hospitals. Will it? Meanwhile, my friend Jeanne Pinder’s uses crowdsourcing to help consumers help each other gather cost data. She blogs about the new study:

This is one of our favorite topics. If you haven’t recently, go to our PriceMap interactive page and play around with the search; for a range of procedures, in cities all over the United States, we show you what the government is paying via Medicare, the program for the elderly and disabled. You’ll be shocked at the range.

Mass. Health Insurance Premiums Bounce Back To Highest In Country

(Source: The Commonwealth Fund)

Massachusetts is #1 again, but not in any way the state will celebrate. We have the highest health insurance premiums in the nation again, according to this annual report from the Commonwealth Fund. Massachusetts bounced back to the top again in 2011 after dropping to 9th place in 2010.

The report does not analyze why Massachusetts is back in first place, but notes that in general, health care costs are higher here because we have more generous benefits, our cost of living is higher overall, and our health care prices tend to be higher.

An important caveat: That high cost of living, and our higher incomes, need to be factored in. If you look at our premiums as a percentage of median household income, we’re actually on the low side: 18% compared to a national average of 22%. (See chart below.)

Still, this bump from 9th back to 1st is bad news. It’s also politically significant. Last year, hospitals and business leaders used this drop in health insurance costs (relative to the rest of the country) as proof that the market was working to curb health care spending. And, they argued, the drop to 9th place meant the state did not need to impose new controls. Leaders made this argument in the heat of legislative debate about what to include or leave out of the health care costs bill Governor Deval Patrick signed in August.

So what do those leaders say now? Continue reading

When The Full Sticker Shock Of Health Coverage Hits Our Family

medical bill

(Attercop311/ Flickr Creative Commons)

As the new state Health Policy Commission begins its work to bring down health care costs, here’s one Massachusetts family’s reminder of why the issue is so urgent. The excruciatingly high prices of both insurance and care mean that some must choose between health insurance and a new furnace, or health insurance and a car. This is not an abstract policy issue; it is a daily burden with major effects. One mother’s story:

By Sara Cushing
Guest contributor

A few weeks ago I resigned from my job as a project manager at one of the largest health care delivery systems in the United States. I have worked in different capacities in the health care industry in the Boston area for the last eleven years, but decided to leave my career because I wanted a change — to follow my dream of becoming a writer.

Many things needed to be considered about such a family-life-altering decision, including one that hadn’t been a concern of mine in the past: what my family’s next steps would be in purchasing health insurance. I have always carried the health insurance — a very robust PPO (“paid provider option”) family plan that was largely subsidized by my employer.

Sara Cushing

Writer Sara Cushing

The direct cost to me (paid bi-weekly on a pre-tax basis) was roughly $400 a month. In discussing my career departure with my husband, we knew that the monthly cost for a similar plan purchased through the Health Connector (the Massachusetts state agency that acts as a vehicle to allow uninsured residents to purchase health insurance through local health insurance companies) would likely be higher. Much higher.

Try something closer to $1700. About the same as our monthly mortgage. About half of what my take-home pay used to be — money that was no longer coming in. And we see no way around it.

Because my husband is in a higher income bracket we’re not eligible for subsidized coverage though the state; and because my husband is a contract employee, his employer doesn’t provide subsidized health care coverage.

This means that we’re looking at the same cost for a family plan whether we buy through his employer; the Health Connector; or through my employer’s COBRA plan (which allows me to purchase the same health care coverage as offered by my employer for up to 18 months after ending employment, though I am responsible for 102% of the cost — the additional 2% is for administrative fees).

I live in Massachusetts, where legislation was passed a few years ago mandating health care coverage for all residents. The legislation helped to create the Health Connector agency so that people could purchase health insurance in larger risk-pools instead of directly from health insurance companies, to allow for more competitive pricing and coverage options for individuals and families.

This all sounds great, right? What many people do not understand, however, is just how steep the monthly premium cost gets, just how painful a $1700 bite out of a family budget can be. Continue reading

Health Cost Panel: Complex Challenges For A Ref Who Can Only Blow Whistle

health cost commission

The new Mass. commission on containing health costs (Martha Bebinger)

As WBUR’s Martha Bebinger was on her way back from today’s inaugural meeting of the board of the new state Health Policy Commission — a key instrument of the state’s health-cost-containment law — she kindly fielded my interrogation: “So what struck you most?” Her reply, edited:

I’d say what stood out to me was that they recognized that the main focus of the law, the key element of the law, is setting a health-care cost-containment goal, but that it is going to be a pretty complex process, both to figure out what that goal should be and to determine the best way to reach it.

Board chair Stuart Altman said he feels like he’s a referee who can blow the whistle but not issue a penalty.

In the area of what that goal should be, what’s at issue isn’t just what the state economic growth is, but what it is over time. So it’s looking more at a trend than at a fixed number, and that’s a difficult concept for many people to grasp, both patients and providers.

We do know what the target is going to be for 2013, 3.6 percent. But this is really a question about the next four years after that, when it’s supposed to be right at the potential Gross State Product.

And then if you start to ask, ‘Okay, so what will it mean to get there?’ that’s when it really gets complicated. Because in the process of figuring out whether providers are keeping costs under control, the state is at the same time trying to overhaul the health care system with a focus on prevention. Continue reading

New Mass. Health Cost-Cutting Law Takes Effect Today

Stuart Altman of Brandeis University, chair of the new state Health Policy Commission

WBUR’s Martha Bebinger reports:

A state law that aims to limit spending on health care takes effect today. 

The law makes Massachusetts the first state to say that health care costs must stop increasing faster than that of most other goods and services.  

A new board that will set a health care spending target and track progress towards that goal has a chairman, and a first meeting date, but the members have not yet been appointed.  

More than a dozen other boards and commissions designed to improve care also exist in name only so far.  

Several provisions in the law take effect immediately or as soon as the state puts new guidelines in place. They include new restrictions on mandatory overtime for nurses, a requirement that providers offer end of life planning to patients nearing death and rules for the use of telemedicine.

There’s a nice recent summary of the law and its rationale here: How a new Mass. law can show the future of health reform.

Latest Data: Average Med School Grad Owes Over $166K

Know a virtuous young person who wants to become a doctor for all the right reasons? Think their soaring idealism might need a bit of ballast from financial reality? Here it is: The latest figures on medical school debt, just out today from the Association of American Medical Colleges.

The mean debt load for students from all medical schools is $166,750, up 3 percent from last year, and the median is $170,000, up 5 percent from last year. And it doesn’t much help if you go to a public medical school — the mean debt is about $156,000, compared to nearly $184,000 for a private school.

Depending on your repayment schedule, the new AAMC data show, your total repayment after graduating could total as much as $476,000. And we wonder why health care is so expensive in this country? Doctors’ salaries are of course only one element of our high price tags, but it’s an element that sets us apart from Europe, where medical education tends to be lower-cost or free. reported recently here:

Meanwhile, tuition rates continue to increase dramatically. The median cost of attending a private allopathic medical school has grown at 1.8 times the rate of inflation during the last 13 years. At public schools, it has grown more than twice the rate of inflation, the AAMC said.

Public medical schools have been particularly hard hit, as states have reduced funding in a poor economy.

Readers, what is to be done? See the full AAMC data below. One interesting note: 30% of graduates plan to enter loan forgiveness or repayment programs: Continue reading

Can My Company’s Wellness Program Really Ask Me To Do That?

doctor exam

(Wikimedia Commons)

“Wellness” is like apple pie, isn’t it? What could possibly be bad about companies helping their workers be healthier?

I wouldn’t dream of finding fault with many typical wellness offerings: Quit-smoking programs, on-site gyms, more appealing cafeteria salads. Good for worker, good for employer, everybody’s happy. But consider this email I received from an employee at a major national retailer:

I see you’ve written several articles about the new health insurance laws, etc. The company I work for has [a major national insurer]. Last year we received a $25 discount bi-weekly if we filled out a health questionnaire, which of course everyone felt compelled to do as that would be a savings of $650 per year. Most people I spoke to felt uneasy doing it, as they felt it would lead to other invasive practices. Well, sure enough, this year, if you DON’T smoke cigarettes you get $10 off bi-weekly, but to get the additional $25 not only do you have to fill out a questionnaire, but everyone employed [here] (and taking the health insurance) has to have a screening which involves:
1. Waistline measurement
2. Blood pressure measurement
3. Blood draw to test for glucose, HDL and triglyceride levels.
If you do not pass these tests, you will lose your $25 if these are not brought down to an acceptable level by August (when we will be tested again).
Needless to say, this really shook a lot of people up, as it is so invasive, and is this even legal?
Would love to hear your thoughts on this.

Let’s cut to the chase. Yes, it’s legal. And it’s a huge trend that began with only “carrots” — discounts on gym memberships, fun health fairs — and is now progressing to sticks. Or at least, to carrots that can feel a whole lot like sticks.

There are some important limits on what your company’s wellness program can do. More on that soon. But here’s the bottom line: Under federal law, your employer can vary your health insurance premium by up to 20 percent based on a “health factor;” that goes up to 30% as of 2014 and the government could eventually raise it as high as 50%.

Why should you foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers?

Readers, what do you think? On the one hand, if you’re a fit, non-smoking, careful eater, why should you have to help foot the bill for all your Marlboro-packing, Miller-cracking, Big-Mac-chomping co-workers? An unhealthy lifestyle is known to be a major contributor to health care bills. and health costs have skyrocketed for years, sending premiums through the roof, hurting businesses and costing jobs. Any levers to bring them down must surely be tried.

On the other hand, there is clearly a potential yuck factor here. Having my employer measure my waist, or draw my blood??? Getting weighed and monitored in the workplace setting, or in the personnel filing cabinet, may not always be comfortable. What if my boss starts a “fun” pedometer contest among our company’s departments and I’m the morbidly obese one? What about my medical privacy? Continue reading

Essay Contest: $1,000 For Best Tales Of Health Care Sticker Shocks

Costs of Care founder Dr. Neel Shah

Costs of Care founder Dr. Neel Shah


Apple-picking. Leaf-peeping. Turkey-eating. And now we have yet another autumn tradition: The annual “Costs of Care” essay contest, seeking “the best stories from patients, doctors, and nurses illustrating the importance of cost-awareness in healthcare.” The contest’s site is here, and it explains:

Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost? How about a time you figured out a way to deliver or receive high-value care?

If your response is “Oh, honey, do I have a story?!” then send it on in to by November 15.

It will be judged by an exceedingly distinguished panel: Pauline Chen and Ezekiel Emanuel, both frequent writers on medicine in The New York Times; Donna Shalala, former U.S. Health and Human Services secretary, and Jeffrey Drazen editor-in-chief of the New England Journal of Medicine.

This is the contest’s third year — Check out the winners from last year and the year before — and I have the sinking feeling there will continue to be a great many stories to feed it for years to come. The contest is run by Costs of Care, a Boston-based non-profit, and I asked the group’s founder, Dr. Neel Shah, for some highlights from this year’s crop so far. He replied:

A medical student from Georgia wrote about her own experience as a patient who went to her doctor with a small lump under her jaw, and the challenges that patients and physicians face in considering unnecessary tests. The lump had all the signs of being benign that she learned about in school but she wasn’t a doctor yet and wanted reassurance. One physician agreed it was probably nothing but suggested a very expensive CT scan “just in case”. Another physician did an exam and expressed great confidence that there was absolutely no need for most testing. What is a patient to do? Continue reading

Maine Hospital Price Lists: Everything’s Better Up North


You know how you cross the border into Maine and suddenly the air feels cleaner and the pine trees tower higher? And the big blue sign welcomes you to “The way life should be”?

Turns out the sign applies to hospital price information, too — at least, more than it does in Massachusetts. I happened to be in a York Hospital lobby in southern Maine yesterday, and came upon a notice informing me that under state law, I had the right to ask for a list of the average price tags on all the most common procedures. Very transparent, I thought, impressed. It sure would be great to post that list on WBUR’s Healthcare Savvy social network.

Turns out it’s not so simple, though. I called York Hospital this morning and they haven’t gotten back to me yet, so I tried the Maine Hospital Association. Jeffrey Austin, the group’s vice president and lobbyist, gave me a very helpful rundown of the background on Maine’s price list. Our conversation, lightly distilled:

What’s the story of this price list?

Around ten years ago or so, Maine law was amended to require hospitals to provide the prices of common procedures. But paper lists are something of a “horse and buggy” version of price transparency, and about four years ago, Maine established an online database — run by the Maine Health Data Organization and funded by the hospitals and the health insurers. It’s publicly accessible and interactive, so you can “one-stop-shop” for common procedures. (The “HealthCost” section is here.) Continue reading

Deval Patrick On Mass. Health Reform, Cancer And Cost-Cutting

Gov. Deval Patrick has had plenty of practice at painting a positive picture of Massachusetts health reform. But I see a couple of points that feel fresh to me in his speech this morning to the American Cancer Society in Washington, D.C.

He says that Massachusetts health reform has led to significant improvements in cancer screening:

Among Hispanic males, a notably under-insured population in Massachusetts before health care reform, the detection of testicular cancer has more than doubled and the majority of cases are now detected at an early stage. And with wider access to screenings, we’ve seen a 36% decrease in cervical cancer in women.

Those are the stats. But even better are the stories. I remember meeting a young woman named Jaclyn Michalos, a cancer survivor who got the care she needed to save her life through the Commonwealth Connector, our version of the Exchange. She had no affordable way before Massachusetts’s health care reform – it saved her life.

A self-employed man named Ken Brynildsen ignored his gastrointestinal symptoms for 3 years because he could not afford to see a doctor or pay for possible treatments. Once insured, he was seen and treated for Stage III colon cancer and is cancer free today.

By using these new tools and new approaches to how we pay for care, we will avoid nearly a billion dollars in cost increases in this fiscal year.’


Patrick also calculates that current health care cost control efforts are enabling the state to “avoid nearly a billion dollars in cost increases in this fiscal year and another several hundred million more next year.” The wording, as you see, is careful, but the message is clear: Massachusetts is starting to contain health costs.

Readers? Do you agree? Here’s an excerpt: Continue reading