health costs


A First-Year Victory In The Mass. Fight To Control Health Costs

(Source: Center for Health Information and Analysis)

(Source: Center for Health Information and Analysis)

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”

Why? It could be the pressure of the new law.

“We have to believe that’s the year,” Boros says, “that insurers and providers are trying their hardest to keep cost increases down.”

But then, health care spending was down across the U.S., not just in Massachusetts, last year.

“There’s not strong evidence that it’s different in Massachusetts; we really seem to be in line with those national trends,” Boros adds. “People are either going to doctors and hospitals a little less frequently, or they’re going to lower-cost settings a little more frequently.”

The result: Health insurance premiums were flat overall in 2013.

2013 average premiums:

Individual: $461 PMPM (1.8% increase 2012-2013)

Small group (1-50 enrollees): $421 PMPM (0.4% increase)

Mid-size group (51-100 enrollees): $444 PMPM (0.5% increase)

Large group (101-499 enrollees): $433 PMPM (-0.2% decrease)

Jumbo group (500+ enrollees): $423 PMPM (-0.8% decrease)

“2013 was a year in which we were able to exhale,” says Jon Hurst, president of the Retailers Association of Massachusetts. But he’s worried the break on rates was short-lived. This year, Hurst’s members are reporting premium increases that average 12 percent.

“If we’re going back to these double-digit increases that so many small businesses suffered through for most of the last decade, we have very large concerns,” Hurst says. “What’s going to happen to the small business marketplace in Massachusetts?” Continue reading

Deluge Of Medicare Data On Docs: Is It Useful? Well, It’s A Step…


Yay, transparency. It’s surely a good thing that Medicare has been releasing gushes of data lately on its health-care payments, most recently on payments to individual physicians. And it’s surely laudable that media outfits like ProPublica are trying to mine the data — on about 880,000 health care providers across the country — to look for overcharging.

But as a patient and health-care shopper, I have yet to see anything that would make me say, “Aha, now that’s useful!” In fact, as WBUR’s Martha Bebinger recently reported, even the new state law requiring health-price transparency is not, in fact, useful yet: “The 26 Steps I took To (Try To) Comparison Shop For A Bone Density Test.”

You can argue in the abstract about the flaws in Medicare’s data release — its failure to distinguish between the easy cases and the complex ones, for example. To follow that tennis back-and-forth, you can read our recent post by the president of the Massachusetts Medical Society and, just out in the New England Journal of Medicine, a defense of the release from Medicare: “The Medicare Physician-Data Release — Context and Rationale.”

But to get a bit more concrete, check out Dr. Patrick T. O’Gara of Brigham and Women’s Hospital, also just out in the New England Journal: “Caution Advised: Medicare’s Physician-Payment Data Release.” He calls the data release a “small but flawed” step toward making medical cost considerations more transparent. I’d hope that it might also be a small but flawed step toward what many of us want most, a way to gauge the quality of care a doctor provides (and avoid the bad apples.)

So is the new data release helpful to Dr. O’Gara or his patients? Well, as I read him, um, no.

As a result of gaining access to these data, will my own patients, for instance, achieve a better understanding of how care is delivered through the Medicare program or be able to compare my 2012 performance, quality of care, and costs with a peer group of general cardiologists at academic medical centers?

They will be able to see the total Medicare payments I received ($64,986.06) and determine with little difficulty that, in terms of Medicare income, I ranked 468th out of 738 cardiologists in Massachusetts and 109th of 291 cardiologists in Boston while seeing approximately 600 more unique beneficiaries and billing for about half as many different procedure codes as the average Massachusetts cardiologist. They will not learn anything about the many other aspects of my practice, the complexity of my patients’ health care needs, or the vagaries of the Medicare claims processes, all of which contribute to the total picture. Some patients will worry that I underachieved; no patients are likely to question how this payment total affected my 2013 salary negotiations. I will not he able to provide insights as to why the Medicare payments I received might differ (either positively or negatively) from that allocated to another general cardiologist who provided comparable services in equal numbers at another academic medical center — nor would I choose to refer my patients for a second or third opinion on the basis of such information.

In short, well, meh, but it’s a start. Readers, has anyone tried to look at the Medicare data? Was it helpful?

Lesson Of The $446 Ear Rinse: Medical Bills That Make You Say ‘What?!’

(Photo: Robin Lubbock/WBUR)

(Photo: Robin Lubbock/WBUR)


Get your attention, all those upper-case, bold-face letters? They certainly got mine, when they came in the mail recently. It was a virginity-losing moment: My first debt-collection letter in more than a half century of financial clean living.

And of course, it was a medical bill that did it — just as it’s medical care that causes more American personal bankruptcies than any other bills.

My health bills for preventive care had all seemed reasonable until now — or at least, they were bountifully paid by insurance. Mammograms, children’s check-ups, all were fully covered. But I’d shifted recently to an insurance plan with a $500 personal deductible, and I’d made a naive mistake: When my doctor kindly offered to clean my waxy ears during my annual check-up last April, I said, “Okay…”

Well, really, how was I to suspect that three or four minutes of whooshing ear-rinse could add up to $446 out of my pocket? (Correction: $446 upon first billing, but knocked down to $338.03 after several long and tortured phone calls, and a medical re-coding. It still struck me as insane, but I paid it to get the collection agency off my back.)

Doctor, if we’re going to cross the line from preventive to billable, I’d like you to let me know.

It’s an ever-more-common American rite of passage: That shocking moment when you unfold the bill, look at the total that is unpaid by your health insurance, and expostulate, “Are you (expletive) kidding me?!?”

Readers, do you have an eye-popping bill and back-story you’d like to share? We’re hoping to make this a series — “Medical Bills That Make You Go ‘What??!'” You can send in your story — and, if you’d like, scans of your bills that will protect your privacy — by clicking on the “Get In Touch” button at the bottom of this page. Goodness knows, you have few other outlets for your frustration.

In my own case, I’m asking you to brave the numbing tedium of any billing tale because there’s a clear object lesson here: Yes, preventive care, including check-ups, must be fully covered by insurance plans under Obamacare. But that doesn’t mean that everything that’s done during a check-up has to be covered.

And therein lies the rub. The line between “preventive” and “diagnostic” or “procedural” can creep up on you, as WBUR’s Martha Bebinger has reported: When Is Preventive Care Free And When Do You Pay? Her report included this valuable lesson: As one Massachusetts woman was horrified to discover, it’s possible to go in for a free — because it’s preventive — colonoscopy, but then, while you’re still on the table, if the doctor finds polyps and removes them, that transforms it into a non-preventive — and thus potentially billable to you — “surgical procedure.”

I’d read that story but clearly I didn’t take its lesson enough to heart. I also take full blame for my longtime practice of getting routine primary care at an expensive top Boston hospital: You can see in the upper right corner of the image above that the initial charge to my insurer for my check-up — which involved no lab tests and nothing higher-tech than a blood pressure cuff — was nearly $1,192.

Still, in hopes that my own financial pain might help others, I asked Blue Cross/Blue Shield of Massachusetts, the biggest health insurer in the state and the one that happens to cover me, for useful pointers. I spoke with Debra Wilson, a senior manager in the Member Service Division. Our conversation, lightly edited:

DW: I think it’s great that you’re highlighting this for people. Folks go in and have preventative visits, and things will invariably come up. The patient is there and having their physical, but they’re also addressing problems. These problems could be longstanding. So it’s important that when something does come up and present itself, that the patient ask questions.

It’s very important that all of us are educated in our health care decisions, and part of that is that we not be afraid to ask, ‘What does that entail and what might the cost be?’

Ask questions beforehand so you’re fully aware of what’s going to be involved, not only with the procedure but the cost. It can generate a liability to the patient, and no one likes an unplanned bill. We’ve also asked our network management team, the folks in the field working with physicians’ offices, if they could also educate the patient at the time — usually after the fact, but let them know, if they were in for a visit and also had a procedure or additional service, that they could receive a balance bill.

We don’t want to discourage these conversations with physicians because it’s probably something they do need to have addressed, and it’s being done all in one trip, so it’s efficient. We just want everyone to be aware of what could happen in terms of cost liability, that that could change depending on services rendered.

The tricky part for the patient is that it can be hard to know whether something is considered preventative or diagnostic or a procedure. For example, at that same checkup of mine, my doctor found that my blood pressure was a bit elevated, so we discussed ways to lower it. Conceivably, that could be billed as not preventive but diagnostic, or an education procedure?

That’s discretionary, based on that particular provider’s office and their billing practices. Certainly, that could be within the preventative visit, but again, I think it’s important not to be afraid to ask those questions.

Would it be reasonable to go into a preventive appointment and say, ‘Doctor, if we’re going to cross the line from preventive to billable, I’d like you to let me know’? Would that be weird? 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

Brown And Warren On Health Care: Two Views Of The Problem

He doesn’t want to turn Medicare into a voucher program (like many of his GOP colleagues) — neither does she. He wants to cut “waste, fraud and abuse.” She wants to cut costs.

GOP Sen. Scott Brown and Democrat Elizabeth Warren offer different perspectives on fixing the health care system

WBUR’s Martha Bebinger offers this portrait of the two U.S. Senate candidates from Massachusetts — Republican Sen. Scott Brown and Democrat Elizabeth Warren — and their differing views on health care:

Brown does not support the Romney-Ryan plan to turn Medicare into a premium support (some call it a voucher) program with seniors buying coverage on their own.

Nor does Warren, who says the main problem with Medicare “is the rise in health care costs, and we’ve got to bring health care costs under control for everyone. And so the question is how we provide needed medical care for all our people at a price we can afford.”

Warren says Massachusetts is coming up with answers through research and pilot programs that will help guide the country. She rolls right into the example of an asthma study at Children’s Hospital.

“What they discovered is they could do more intensive treatment at the beginning,” Warren explains. “And for every dollar spent, they saved $1.46. They got those kids healthier, they kept them out of the hospital, fewer trips to the emergency room, and to me, there’s the heart of the game.” Continue reading

Live: MA Senate Debates Health Care Cost Bill

As we speak, a debate on S.2260, the Senate’s health care cost bill, is underway. You can watch it live here.

But get comfortable: staffers report there are 265 filed amendments to consider.

Lawmakers weigh in on the Senate health care cost bill

Update at 4:53: The Senate voted 15-22 rejecting amendment #125 that sought to trigger a single-payer health care system.