Getting personal about the cost of care

Health care is very personal, and this includes the financial aspects of how we pay for care.

Costs of Care, a nonprofit organization dedicated to raising the level of awareness about medical decisions and how they affect what the patient pays, has announced the finalists in its second annual essay contest – and I can’t wait to read the entries.

There’s the story of Renee Lux, a patient from Connecticut who received an unnecessary CT scan for neck pain and ended up being branded with a pre-existing condition that caused her health insurance premiums to go up.

There’s Melody Chung of California, whose mother underwent a barrage of diagnostic tests for fleeting chest pain and was charged an unexpectedly high bill.

There’s Molly Kantor, a medical student in Massachusetts who helped treat heart failure on a $100 budget by avoiding an unnecessary hospital admission.

Winners of the essay contest will be announced in mid-January. Entries will appear on the Costs of Care blog throughout 2012.

This is the second year Costs of Care has sponsored the national essay contest. More than 100 entries were submitted from across the U.S. The distinguished panel of judges includes C. Everett Koop, former U.S. Surgeon General; Peter Orszag, former White House budget director; Jennifer Granholm, former governor of Michigan; women’s health advocate Dr. Susan Love; and Alan Garber, Harvard University provost and health economist.

In the intense, ongoing national conversation about the cost of health care, it’s easy for individual stories to become lost in a sea of statistics and arguments. The personal stories are a reminder that this issue is more than academic; it’s about real lives and real people. Watch this space for the announcement of the essay contest winners next month.

Getting personal about the cost of care

Even being a doctor doesn’t necessarily make you immune to hassles about health care costs, as Dr. Jeffrey Rice, chief executive of Health Care Blue Book, described recently at the Costs of Care blog.

Dr. Rice’s 12-year-old son needed to undergo relatively minor surgery on his leg. The family had a high-deductible health plan and wanted to know in advance what it would cost.

Dr. Rice explains:

I called the hospital to request a price for the surgery and they said they couldn’t really tell me. They offered to send the procedure codes to an external reviewer who would provide a general idea of the anticipated charges. Three days later the answer came back at $37,000. I reiterated that I had high deductible insurance and needed to know the actual price they would bill me after an insurance adjustment to the network fee schedule.

The hospital next referred me to my insurance company. The insurance company referred me to their PPO network. The PPO network said that they could not reveal the prices until after the case was performed.

Health care consumers are often criticized for not thinking about the cost before seeking care. But when doing your homework involves negotiating an obstacle course worthy of the Green Berets, it’s not hard to see why many people give up after encountering the first few barriers – or worse yet, don’t even try.

Luckily Dr. Rice was persistent. He decided to ask the surgeon if the procedure could be done at an independent ambulatory surgical center. The answer was yes. “One phone call and 10 minutes later I have the exact price for his surgery – $1,515,” Dr. Rice wrote. “My son had his surgery and is doing well. We got a fair price because we demanded more of the system.”

Stories like these are a real-life example of how cost intersects with the care patients receive and how challenging it can be to link the two in a meaningful way.

Costs of Care, a nonprofit organization based in Massachusetts, is looking for stories about the cost of care for its second annual essay contest.

Consumers and providers are invited to submit personal anecdotes illustrating how cost awareness led to high-value care and/or cost savings, or how a lack of cost awareness led to an unexpectedly high bill or difficulty figuring out what a test or treatment would cost.

Four $1,000 prizes will be awarded to the winners. The contest deadline is Tuesday, Nov. 15. Finalists will be announced Dec. 15; the winners will be announced Jan. 15. Click here to read more about the contest rules and how to submit an entry. And watch this space for contest updates and links to the winning entries.

For what it’s worth, I don’t buy the argument that it’s too difficult for health organizations to give patients an estimate ahead of time for what their care will cost. Here in Willmar, Minn., Rice Memorial Hospital has been doing this for the past year with the help of a software tool called CarePricer. By all accounts, it’s quite accurate, even taking into account how much of the patient’s deductible has already been met for the year. I’ve heard anecdotally from hospital staff that in a few cases, patients have decided to delay elective surgery after learning what their out-of-pocket costs would be. It takes work to put this kind of process into place but clearly it can be done, and done successfully.