Would you save money by going to a doctor who publishes prices online?

Author: Jennifer Graham, Deseret News. For original article, visit deseretnews.com

 

SALT LAKE CITY — Dr. Rick Henriksen doesn’t wear a white coat, and that’s not the only thing that’s unconventional about his practice of medicine.

Henriksen, a family physician in Salt Lake City, is embracing a new model of health care delivery, one in which doctors publish their prices online and scale back their reliance on health insurance companies for payment, or shun insurance altogether.

Instead of making a co-pay and allowing the doctor to file a claim to their insurance, patients at Henriksen’s new practice will pay a monthly fee that covers in-person visits, telemedicine and even house calls. People who don’t sign up for a membership can still get an appointment with Henriksen by choosing from his “a la carte” menu and paying with cash. He doesn’t take insurance.

Dr. Rick Henriksen meets with a new patient, Tara Norton, at Liberty Park in Salt Lake City on Friday, Sept. 8, 2017. Rather than meet in his office, Henriksen rode his bike to the park to take a walk and get acquainted with his new patient. (Spenser Heaps, Deseret News)

About 250 miles away, in Cedar City, Utah, Dr. Randy Delcore does accept insurance, but his outpatient surgery clinic has begun to publish its prices online, an innovation that has drawn new patients from all over the country.

Both monthly memberships (also called direct primary care) and straightforward pricing are trends in a phenomenon called “price transparency,” which the Robert Wood Johnson Foundation said can ultimately lower the price of health care.

“The historical opacity of health care prices is widely believed to be a major factor inhibiting the more efficient functioning of the delivery system,” the foundation said in a policy statement last year. “Health economists and other experts are convinced that significant cost containment cannot occur without widespread and sustained transparency in provider prices.”

The Affordable Care Act was designed to make health care more affordable, but the average family premium has increased 58 percent since 2006, according to the Kaiser Family Foundation. Meanwhile, more than 4 in 10 Americans with insurance have high-deductible policies that may discourage them from getting health care. The move toward transparency could help these families by allowing them to find lower-cost providers and by shaking up health care delivery in other ways.

Health care costs (Heather Tuttle)

Not everyone agrees price transparency will lower overall health care costs. One physician argued in the Journal of the American Medical Association that transparency is not a “panacea,” noting that when patients are provided prices of different providers, some choose the highest-priced services to help them reach their deductibles.

Further, “it is not clear to what degree patients function as consumers in medical markets,” wrote Dr. Kevin G. Volpp, director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania. In one study, only 10 percent of patients given access to a price-transparency tool used it to look up prices.

Other health policy analysts warn that the new models of medicine further fragment an already splintered system of health care and will worsen a shortage of primary care physicians.

However, those issues aren’t usually on the minds of people who need medical care and either don’t have insurance or have a deductible that makes their policy irrelevant. These people want to know how much an X-ray or bunion surgery costs and where the lowest-cost provider is, and the trend toward transparency is meeting their needs.

A walk in the park

Although his new practice, called Kestrel, doesn’t officially open until Sept. 18, Henriksen is already seeing patients who’ve signed up for the service. “You can almost think about it like a gym membership for your doctor,” said Henriksen, 38, a Utah native who went to medical school in New York and previously taught at the University of Utah School of Medicine.

Kestrel members can choose from three tiers of service for individuals or families. Prices range from $125 to $350 a month for family coverage and $75 to $200 per month for individuals. Henriksen expects most of his patients will be members, but he also offers clinic visits for $200 and house calls for $250.

The structure frees Henriksen from time-consuming paperwork and the need for staff; one study published in the Annals of Internal Medicine found that physicians spend two hours doing paperwork for every hour spent with patients.

For patients, direct primary care takes away a disincentive of the traditional model — paying for every visit — and allows them more time with a doctor who is more invested in their care, he said.

In a traditional clinic, Henriksen said he would care for 2,000 patients over the course of a year; at Kestrel, he will see no more than 400. And although he has an office in Salt Lake City, he anticipates doing a lot of house calls and telemedicine. He will also encourage patients to meet with him in nontraditional settings, such as a park.

“I want to remove the pain points of seeing a doctor. One of the biggest pain points is actually going to a doctor’s office and clinic. It’s not a fun place to go to. It takes time, you have to take time off work and it’s inconvenient. For me, it makes a lot of sense to see people in their own environment, where they’re comfortable.”

Henriksen said he also likes to see patients outside, which is easier to do with a direct primary care practice that isn’t driven by billing codes and a clock.

“We’ve become so accustomed to sterilized medicine. … There’s no reason you have to see someone in this sterile little room when you’re talking about their depression or insomnia,” he said. “It gets me outside, it gets them outside and you’re still able to get a lot of great stuff done.”

Dr. Rick Henriksen meets with a new patient, Tara Norton, at Liberty Park in Salt Lake City on Friday, Sept. 8, 2017. Rather than meet in his office, Henriksen rode his bike to the park to take a walk and get acquainted with his new patient. (Spenser Heaps, Deseret News)

Changing the dynamic

When Dr. Randy Delcore began publishing prices at Cedar Orthopaedic Surgery Specialty Clinic in southern Utah, he discovered an unexpected benefit — people began calling from all over the U.S.

Because Delcore’s prices for joint replacement are cheaper than in other regions and in hospitals and he’s made them easy to see, some patients found it saves them money to travel to Utah to have procedures done, said Daron Pealock, a registered nurse and the office administrator of the clinic.

This amounts to domestic medical tourism, which is more practical — and sometimes safer — than international medical tourism, Pealock said. The surgical clinic has even devoted part of its website to promoting things visitors can do in Utah before or after their appointments, such as visiting Bryce Canyon or Zion national parks or attending the Utah Shakespeare Festival.

“And you have continuity of care, which is one of the most important things that we offer,” he said.

Pealock said some of the clinic’s patients have catastrophic or Christian cost-sharing policies and are paying out of pocket, so they are taking time to do research and find the best value and a doctor with whom they are comfortable.

“Back in the day, insurance was designed to be for catastrophic events; it wasn’t meant to treat your day-to-day issues,” Pealock said. “It’s evolved over the years to where it’s 360 care, which is good to a point, but because of business and insurance, people have gotten left behind a little bit.

“We’re a little more traditional. We’ve changed the dynamic a little, and people appreciate that. They are always surprised when I give them my cellphone number. That doesn’t happen anymore.”

Other factors to consider

The price-transparency movement, in many ways, is a return to the past, when physicians went to private homes to treat patients and left with payment that could be cash or two dozen eggs and a live chicken.

The return to old payment structures might be appealing to seniors, and direct primary care as Henriksen offers may be especially beneficial to older people with chronic conditions or those who have a hard time getting to a doctor.

Dr. Rick Henriksen meets with a new patient, Tara Norton, at Liberty Park in Salt Lake City on Friday, Sept. 8, 2017. Rather than meet in his office, Henriksen rode his bike to the park to take a walk and get acquainted with his new patient. (Spenser Heaps, Deseret News)

But such innovations in health care are also driven by young people, who expect to make appointments for in-person visits online and feel comfortable seeing a doctor over a webcam. Millennials, in particular, are skeptical of an antiquated health care system in which costs are disparate and hidden.

“It’s hard for me to believe that those young people are going to grow into adults who find it acceptable, when they ask their provider how much something costs, for their provider to say ‘I don’t know’,” said Andrea Ducas, a program officer at the Robert Wood Johnson Foundation.

“In a culture of health, we want to make the healthy choice the easiest choice,” she added. “The choices we make depend on the choices we have. If we expect people to shoulder the burden of health care expenses, it’s unfair to not give them the information they need to make those decisions.”

Volpp, the Pennsylvania physician and economist who warns that price transparency is not a panacea, agrees — to a point.

“The medical profession exists to serve the needs of patients as customers, so it seems reasonable for those patients to have some idea of what procedures/services/tests will cost,” he said in an email. To only focus on cost, however, ignores other important factors, such as the skill of a physician, he said.

Moreover, “The benefits of price transparency in terms of making consumers more aware of significant variations in prices are more relevant in settings outside of primary care where expensive procedures or tests are more likely to be performed,” Volpp said.

Outside primary care, however, is where costs can begin to add up and become a problem for cost-conscious consumers who don’t have insurance. Health care memberships — whether in primary care or dental practices — don’t help when people need a specialist or hospitalization.

Doctors who operate “off the grid” have an ethical obligation to ensure that their patients understand this and to make sure their patients have, at minimum, a catastrophic-coverage policy, said Carolyn Long Engelhard, director of the Health Policy Program at the University of Virginia School of Medicine in Charlottesville, Virginia.

“Under the Affordable Care Act, which the physicians may hate and which we know has problems, poor, uninsured people who can’t get health insurance at their jobs can qualify for pretty large subsidies and get comprehensive insurance,” Engelhard said.

“Now, it may carry a fairly hefty deductible, but they will not go bankrupt if they have cancer or get in a horrible automobile accident. That’s the trade-off,” she said.

‘Nobody is trying to be obscure’

When paired with insurance, direct primary care can be beneficial to the patient and the doctor, but at a cost to society, Engelhard said.

When family doctors go from caring for 2,000 patients to seeing 600 in a year, “What are those other patients in the community doing? Where are they going?” she asked. “It exacerbates the shortage of primary care physicians. Yes, we have problems with primary care physicians and 10-minute visits, but this is not the answer,” she said.

Another problem, Engelhard said, is that when doctors opt out of insurance networks, including Medicare and Medicaid, they lose the layers of accountability that exist within the system and become accountable only to patients, who may lack the knowledge to assess the care they are receiving and are often reluctant to change providers even when outcomes are poor. “The ability to practice medicine without anyone asking about your outcomes is so 20th-century,” Engelhard said.

Further, when doctors act as small-business owners, “you’ve lost a little bit of the soul of medicine,” she said.

“I think we should all be working to have a system that serves all Americans rather than having a fragmented system that pulls out certain groups of people and separates them.”

For now, the new models are a niche of health care, and they may remain so, as long as the majority of Americans have health insurance.

According to the Kaiser Family Foundation, 49 percent of Americans have health insurance through their jobs, and about 34 percent have Medicaid or Medicare. About 9 percent have no insurance at all.

With more than three-quarters of Americans saying they live paycheck to paycheck, relatively few would be willing or able to pay for both health insurance and a direct primary care membership.

The number of Americans who have high-deductible policies, however, exceeds 40 percent and in most states is growing, which is one reason that price transparency is “an emerging area of practice and of interest to us,” said Dr. Ripley Hollister, a family medicine specialist in Colorado Springs and a board member of The Physicians Foundation, a nonprofit that advocates for high-quality, cost-efficient health care.

Physicians have been hamstrung by the prevailing model, in which they aren’t allowed to discuss what they are paid because of insurance and government regulations, he said.

“Speaking for physicians in general, nobody is trying to be obscure. It’s just that the whole process ends up being obscure and opaque. Our contracts are constantly changing. Someone says ‘I have Blue Cross Blue Shield’ and there are probably hundreds of Blue Cross Blue Shield contracts. Nobody has the ability to keep up with all of this on a daily basis,” Hollister said, adding that some of his contracts with insurance providers are 30 or more pages long.

“We’re seeing this as an emerging trend, but it’s applicable to a limited number of practices right now. We’ll see. Who knows where health care is going right now? We’re all waiting,” he said.

You Shop for Good Deals on Steak – Try Cash Pay Surgery Centers!

Medical and surgical pricing is not getting any less expensive. This is despite the enactment of the Patient Protection and Affordable Care Act which was signed into law by President Barack Obama in March of 2010. The general promise of less expensive health care may have given many people the assurance that shopping for health care services would not be necessary. However, that has not been the case. Yet cash pay surgery centers offer a solution to this situation.

Obama made several promises in regard to this new law. Here are a few of them, and the actual results in respect to this law. Let’s just say that they were merely political promises. You know how that works.

If you like the plan you have, you can keep it.

PolitiFact dubbed this promise “Lie of the Year” in 2013, as the nation approached the opening of the Obamacare exchanges. As it turns out, approximately 4 million Americans received cancellation letters from their insurance companies. That resulted in a huge political uproar.

Additional legislation allowed some plans to be “grandfathered” as ACA-compliant plans. However, the regulations on Obamacare insurance plans were generally so strict, according to PolitiFact, that even a small deviation from ACA regulations resulted in canceling the plans that failed to meet the new guidelines.

If you like your doctor you can keep your doctor.

According to a July 2013 article in the Weekly Standard, the U.S. Department of Health and Human Services had to backtrack a bit on President Obama’s hasty promise. Apparently, HHS added some questions and answers to information provided on the Healthcare.gov website that addressed the doctor issue.

The answer to the question, “Can I keep my own doctor?” became a “maybe” rather than a promise kept. The language on the website reads as follows.

“Depending on the plan you choose in the Marketplace, you may be able to keep your current doctor.”

Clearly “may” was the operative word. There were no guarantees on that promise because certain doctors would only be available in certain networks. Additionally, as the years have passed, many areas of the country were reduced to having only one insurance carrier available on the Obamacare exchanges. When those carriers had very narrow networks, the chance of people being able to keep their preferred doctor continually decreased.

You will be able to save approximately $2,500 a year in premiums.

Yes, this promise went down in flames as well. According to a September 2015 article on the Investor’s Business Daily website, premiums for a family INCREASED by a total of $4,865 between 2008 and 2015.

Enough said on history.

What to do about the continually escalating prices for health care services and insurance premiums?

It’s high time to go shopping for health care services!

Americans seem to have fallen into some sense of dis-empowerment as they have become too accustomed to our health insurance companies. It seems like insurers are “taking care” of everything involved with the delivery of our medical and surgical care. We see the insurance companies work with the doctors to “grant” pre-authorizations. Sometimes insurance representatives even call patients before a procedure with all kinds of “helpful hints”. The one service missing in those “helpful hints” is preparing us for the costs we may have to shovel out for the procedure.

The main explanation for this situation lies in the fact that way too many insurers have very narrow networks. These networks pretend that they are the best deal available to enrolled patients. Unfortunately, that could not be further from the truth.

Patients may prefer, in fact, to ignore the insurance hassles and look for cash pay surgery centers. Some may be nearby. Others may be quite a distance away, but even with the cost of travel and lodging added into the mix, those surgery centers may offer the most affordable surgery option.

How the insurance system works

When the average person asks a hospital billing department what the cost may be for an upcoming surgical procedure, the first reply is … “It depends on your insurance.” Why is that? In our crazy health care world, each insurance carrier has pre-negotiated a “discounted” price for procedures with each provider in its network. And guess what! These negotiations are always considered “proprietary”. That’s just another word for secretive.

The only way to get a preview of the amount you can expect to pay for an upcoming procedure is to call your insurance company. If you do this, give them your insurance information and ask what the allowable rate is for the procedure. It’s a good idea to find out the procedure code before you call to get the most accurate information. Your doctor’s office can usually supply this for you.

Here’s a hint of what you may learn though. Your procedure will most likely to be extremely expensive at your local hospital because of the little kabuki dance hospitals and insurance companies play. The hospital charges some ridiculous price for services. Then the insurance company pre-negotiates that down to a relatively less disturbing reimbursement. That is considered the “discount”. The strange thing is, some of the hospital charges may have NOTHING to do with a reasonable cost of care plus reasonable profit.

Don’t get blindsided!

If you couldn’t extract the price and “discount” from the hospital or insurance company before your planned procedure, you could be in for a rude surprise when the bills start coming in. One woman who had a procedure done at a large medical center in Oklahoma City saw her bill for two surgeries on the same day, and the total was approximately $115,000. Worse yet, when she went over the bill with a fine tooth comb, she found that the hospital had charged $15,076 for four tiny little screws.

One person who represented the company making the screws weighed in on the issue. He said that he could not divulge exactly how much the hospital had paid his company for those screws, but he gave a ballpark price for their general going rate. He said his company sold most screws for orthopaedic procedures for approximately $300 per screw. The most expensive screw sold for $1,000.

The hospital, however, charged $3,769 per screw, gathering a far higher profit than necessary. It is most likely that other charges on that bill were just as outlandish, given the total bill.

Finding your least out-of-pocket (LOOP)

Many Americans these days have very high deductibles. This applies to those whose employers cover them as well as those who are individually covered. In light of the high costs for many procedures, the current trend among many employers is to place more of the out-of-pocket burden on employees. This burden takes the form of higher deductibles and co-insurance (another patient out-of-pocket expense).

It’s time for patients to realize that they have the power to shop for care. It may require some extra effort, but it can be very rewarding in terms of finding your LOOP expense. If you have been diagnosed with a condition that makes non-emergent surgery likely, don’t be content to blithely go to the hospital nearest you without knowing what you can expect cost-wise. Also, if you have one of those deductibles that are more than $3,000, you may benefit from shopping around for cash pricing that leaves out the middleman. In that case, your best option may turn out to be looking for cash pay surgery centers.

Price transparency at cash pay surgery centers

There is a new trend in medical and surgical services that can make shopping for the best price on procedures worth your while – it’s called price transparency. This movement is growing in popularity, especially among those who want to be financially prepared for their procedures. In fact, many cash pay surgery centers participate in this trend.

Cedar Orthopaedic Surgery Center is proud to participate in the price transparency movement. Although the center proudly accepts insurance, we are also a cash pay surgery center. We have been posting our competitive bundled surgical prices on our website for many years. If you have been diagnosed with an orthopaedic condition that requires surgery, go shopping for that surgery before you commit to it at any particular facility.

By going to our home page, you will find our price transparency tool on the home page. All you have to do is click on the body part that corresponds to your surgical need. Then a list of procedures for that body part will appear. Click on the applicable procedure and find out just how inexpensive surgery can be. Checking out cash pay surgery centers in your search for more affordable procedure pricing can be especially helpful if you don’t have insurance or have a very high deductible.