American Morning
Prescription for waste: Health care bargain hunting
Editor's Note: All this week, in the American Morning original series "Health care – Prescription for waste," we're examining more waste in the health care system – and this time it could involve your money. Today, our Elizabeth Cohen goes shopping for health care to show you how you can save hundreds when it comes to your own medical bills. Tomorrow on American Morning, we look at one hospital's war on unnecessary and outrageously expensive procedures.
(CNN) – You might think that bargain hunting is only something worth doing in a department store or a supermarket, not a hospital. But as our senior medical correspondent Elizabeth Cohen found out, that might not always be the case.
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I have been watching the healthcare segments this week and have been very disappointed by the reporting of the issues surrounding healthcare costs. The information which has been provided is superficial and does not accurately portray the differences between costs, charges, and revenues that hospitals must navigate. In fact, the reason for the disparity in numbers from hospital to hospital is based on the insurance industry, beginning with the system Medicare has in place. Rather than portraying hospitals, who are non-profit in most cases, and barely generate enough money to maintain their physical plant and staffing, please investigate and report on the disturbing regulations and contractual issues which make hospital billing a lesson in advanced calculus minus the logic.
I also had to comment on the report this morning (that hasn't been posted yet) which mentions c-sections. I am glad that someone is reporting about how the high rate of c-sections are contributing to the high cost of health care and that many are NOT necessary. It is true, no one has been sued for doing too many c-sections, but that is part of the problem – as a society (therefore how juries may respond to a lawsuit), we don't view the complications from a c-section as unnecessary, but they often are. Yes, it is MUCH cheaper to have less interventions, and the outcomes are better! And in those truly necessary emergencies, thank goodness we have the medical knowledge and skills necessary to save the lives of the mother and baby. But hospital births are not always safer, despite that general belief.
But what really made me outraged was anchor Kiran said that her doctors say "technically" c-sections are safer?!? No, they are NOT!!! Check the facts. It's those kind of flip remarks (and I'll include John's comments about docs wanting to get to golf/tennis games in this) seem very unprofessional because they are coming from CNN anchors, so many will believe them, but it's not real reporting. Please be more careful about what you say guys!!!
Your AM Fix story about C Sections was very interesting but you host implied that doctors do c sections for the added compensation. He should know that the extra $200 is hardly a reason that most doctors do this operation. (It should also bre pointed out that many insurance companies don't pay a differential for c sections.) He also said the operations are done to get to the golf or tennis courts. This is insulting to the vast majority of honest and hard working Ob/Gyn's who stay up all night and on weekends delivering their patients. People want healthy babies and healthy mothers and don't want to take any chances and this is a reason for the increase in c section rates. Tort reform can be a major factor in bringing down c section rates. No one has ever been sued for doing too many c sections.
Doctors may say that a cesarean section is the best option for the child, but that is flagrantly untrue! Look at the statistics! C-section is not the safest way to birth a child, nature birth is. Obviously, there can be complications in which a c-section is warranted, but if you compare the United States to other countries the rates of birth by biomedical providers are very low. Births around the world are being done by midwives. If you want to talk about saving costs in this country, when it comes to birthing procedures, look at birthing centers. A hospital birth costs anywhere from $15,000-$30,000, while a birthing center costs approximately $1,500.
I AM A DOCTOR and like many other tax paying insured Americans, especially those who pay insurance for themselves and their employees, I am a victim of our system. There are multiple complex interacting reasons for healthcare to be ridiculously expensive. In summary it is mostly because of the following: technology and skilled personnel are expensive, the necessity of legally defensive provision of products and care add additional procedures and cost, administrative bureaucratic requirements impose inefficiencies and cost, the health of average Americans is poor which adds cost, and the mindset of Americans is to prolong life at all cost and provide the best care regardless of cost effectiveness, and additionally hospitals and particularly ER’s are inappropriately over utilized and are the most expensive component in the system.
Until you reduce the cost of PROVIDING healthcare you cannot significantly reduce the cost of receiving it. The debate now is mainly centered on who should pay and of course those who can't afford it feel righteous in believing someone else should pay their exorbitant costs imposed by a system in which they have no control. Those who are successful enough to afford it, righteously feel they should not have to pay for both their care and also for others, especially when other's bad health habits increase costs they have no control over. So control of costs is an issue to both groups and are both are frustrated by the escalating costs. The debate desperately needs to shift to WHY it is so expensive to provide here and why it is less expensive elsewhere.
First, healthcare is expensive to consume because the latest technology is expensive to develop and provide. Trained personnel, medical supplies, drugs, and anything connected with human care is expensive and requires compliance with ridiculously burdensome bureaucratic requirements and redundant DOCUMENTATION as well as exposure to risk of lawsuits.. (About 70% of every dollar I collect goes to overhead cost). EVERY entity in the supply chain spends money to both comply with every government requirement imposed as well as pay for insurance to defend lawsuits and enforce additional procedures to prevent them. (You can’t watch TV without seeing an ad to sue someone for an adverse healthcare event). YOU PAY MORE!
Second, Americans are the fattest, sickest, least physically active people in the developed world. It costs an estimated $50 per extra overweight pound per person per year on average because obesity causes diabetes, heart, stroke, joint, cancer, back, disability, and numerous other complications that require expensive treatment. If Americans could return to average obesity levels of 1991 we would save a TRILLION dollars annually on healthcare expenses. Junk food and the TV/Video game lifestyle are huge contributors. Juvenile diabetes has doubled in the last 20 years. In Mississippi 44% of children and 33% of adults are obese. Colorado is the only state with less than 20% obesity at 19 plus %. America actually is the best in the world at treating and curing disease but it is more expensive and we do a very poor job at preventing disease. Much of prevention has to do with smart lifestyle choices and education but 25% of American children drop out of high school (50% in Chicago!). The dropouts not only end up being less healthy but they also end up on taxpayer subsidized government entitlement programs. Go to WalMart and do the math or maybe just get on the scales and look in the mirror. Do you and your friends exercise and eat healthy?
Third, Americans are getting older, sicker and living longer. About 80% of all Medicare dollars are spent on the last 6 months of life in trying to keep dying people alive. We have a philosophy of believing that preserving life, regardless of the quality, is a top priority regardless of the cost. That’s fine, but all the latest technology and expense has to be paid for by somebody. We do have amazing technology and can even send man to the moon. Unfortunately, we can’t afford to send all men to the moon and we can’t afford to continue to spend a disproportionate amount of our limited resources on futilely trying to avoid death in advanced age and terminal disease. Is it reasonable to spend $500,000 to keep someone on life support an extra month when the situation is hopeless? Common sense, kindness and compassion are more appropriate when the inevitable is near rather that feeding tubes, ventilators, and the latest invasive technology. While death is a difficult issue, if you believe in God and an afterlife then accept it embrace it as it is as natural as birth and an inevitable consequence thereof.
Fourth, Americans want the latest, greatest, best technology, drugs, care and everything else when they or their loved ones get sick regardless of the cost. This, of course is if it doesn’t cost you out of pocket. If you are on a government program it isn’t a problem to you because taxpayers are footing the bill. The same mindset largely holds once insurance deductibles have been met. The problem is that often the very best may only be 10% better than something that costs 10 times less which multiplies cost inefficiencies. Most doctors feel their mission is to provide THE BEST care and don’t know or care about the expense and patients only find out after they get the bill if the government or insurance doesn’t pay.
Fifth, hospitals are inefficient bureaucracies and hugely wasteful of resources. They lose money big time on uninsureds (e.g. illegal immigrants), don’t make money on Medicaid, barely make a profit on Medicare and those on insurance have their rates jacked up to make up the difference. You can’t go to the hospital or ER without having a test done for every complaint no matter how minor (don’t want to get sued). Plus, because of all the bureaucratic governmental requirements and documentation, everything costs 10 times what it should. It is also easier to pass high costs of supplies to patients through higher charges rather than negotiate better prices with suppliers. Every pill or band aid you get has to be precisely documented in triplicate by a series of highly trained expensive personnel in order to maintain government licensure required to stay in business. Worse, some people (especially on Medicaid who pay nothing) run to the ER for every minor illness out of either ignorance or convenience which escalates costs to either the government (that’s you if you pay taxes) or the insurance company which passes expenses to you via raised rates. And finally, a lot of people get admitted to the hospital when they really could be treated as outpatients with a little education and family support. Often families prefer the convenience and security of the hospital rather than have their lives disrupted by having to provide care at home, especially when the government is paying.
Last, there are other factors as well, but I am disgusted with politicians ignoring most of the real issues which need addressing but if you want to understand why your insurance rates and taxes keep rising, you can start with all of the above.
PS Forgot fraud. While nobody knows, I strongly suspect that the majority of fraud is committed NOT by providers but by recipients of entitlements who fraudulently misrepresent their financial status. Of course, it would be politically incorrect to even check.
We can shout, argue, and complain all we want. Until WE the people take charge of this situation, FORCE our "elected" children to represent US, then we will continue to pay for it! Dems, Reps, Left, Right, Center, Red dogs, Blue dogs, hot dogs, christian, atheists, and what the heck else can we throw into this to screw it up a little more?
Could we be any worse it we threw out all of these spoiled brats and start over?
@ Jim, perhaps your doctor posted the information about those two hospitals in regard to the fact he may only be contracted / credentialed with them, even if there are more in your area. You must be familiar with your 'in / out -of network benefits' if you do have insurance. If you do not have insurance then you are not governed by that but are restricted by which facilities your doctor can practice so, yes if a procedure costs less at a hospital where your doctor is not affiliated, then you would have to ask more questions directed to your doctor and chosen hospital and perhaps have to change doctors for care and that change might save you some change,at the end of the day.
While listening to the concept of shopping around hospitals for the least expensive service I wondered what would happen if my doctor prescribing a colonoscopy or hernia operation was not accepted by the cheaper hospital. It has always been my thought that hospitals only approve certain doctors. My own doctor has a posted notice to the effect I should go to only two hospitals in the city. By going to a less expensive hospital wouldn' t that mean I would have to find a new doctor?
I have worked in several specialty doctor's offices scheduling the procedures (and others) Elizabeth was covering during this mornings' report. Having learned to offer only an estimate of the cost of a procedure is the best office policy a scheduler can adhere to. The patient is responsible for the insurance coverage they carry and should know what procedures are a covered benefit and what facilities are within network. The patient can ask for a code from the billing department of the referring doctor, which represents the procedure and from there they can 'shop' hospitals for the lowest price to 'buy' the procedure they need. As Kiran was asking how to make the availability of "shopping" more transparent for the patient, I offer to curious patients to try this approach.
I think the report fails to mention if these prices are actual prices or prices with insurance. Also mindset and emergency wasn't looked at. If you're having a heart attack, I doubt you'd want to call around for pricing.
Kiran, I was watching the CNN morning news when I heard your story about the outrageous prices charged by hospitals and healthcare providers. What I don't think most people understand is that hospitals are not making big profits off healthcare these days. I was at a meeting at my hospital in Pekin, Illinois the other day when the CEO announced that the ER has a 60% NO PAY rate right now. That 60% of the costs gets price shifted to the 40% of people who do pay. And that percentage of people not paying their bills is getting larger every day. Another huge cost for hospitals is their malpractice premiums that get price shifted to the 40% of people that do pay their bills. These are just 2 of the many problems with the healthcare system right now. I could go on, but I won't.