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VARIED HEALTH CARE COSTS LEAD PUSH TO EMPOWER PATIENTS

By: Nicola Heredia, CHS Marketing Coordinator

Health care services can vary in cost from state-to-state and even sometimes, from one hospital to another. The lack of continuity and regulation when it comes to what hospitals and doctors charge makes it difficult for patients to shop around.

While health care reform looks to make the insurance marketplace more competitive, there has been little effort made to regulate medical charges. Although hospitals and doctors may have their reasons to back-up their fees, little information is published or made public.

“There’s very little transparency out there about what doctors and hospitals are charging for services,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, in a New York Times article. “Much of the public policy focus has been on health insurance premiums and has largely ignored what hospitals and doctors are charging.”

In 2013, the Centers for Medicare and Medicaid Services gathered data from 3,300 hospitals nationwide to analyze the difference in how they were charging their patients. For surgery to implant a pacemaker, one hospital in Livingston, NJ charged $70,712 on average compared to $101,945 in a nearby hospital in Rahway, NJ.

The study displayed many other examples similar to this one. While other factors played into the cost difference, the overall takeaway from the study is that patients are unaware of what one hospital or doctor charges to another.

Without having that knowledge, how can they make fiscally responsible, smart decisions?

Obamacare was the first push to motivate Americans to shop around for insurance and find a plan that works with individual’s financial situations. Most recently, industry leaders have called for patients to take control over the health and know exactly what they are paying for.

“It’s so important for patients to know what they’re getting tested for – the risks and limits of testing,” says Patrick McManus, residency director at Thomas Jefferson University in Philadelphia, in a USA Today article. “And to know how sensitive the test is: how likely it is not to miss disease if you’ve got it, and how likely a positive result is actually a true positive.”

When visiting the doctor, it is important to communicate and ask questions to know exactly how the doctor wants to proceed. It can be easy for providers check the boxes and order additional screenings, but it is up to the patient to communication with their doctor to eliminate unnecessary testing.

“Patients who are actively engaged in their own health care are more likely to stay healthy and manage their conditions,” reported Senior Program Officer at RWJF Susan Mende in RWJF article. “It is important for physicians and their teams to work with patients to ensure they have the knowledge and confidence necessary to take control of their own health – where most health decisions happen – outside of the examination room.”

On Patients.About.com, there was a guide published on how to become an empowered patient. Here are five steps that patients need to take to move toward that goal.

  • Take responsibility and make decisions about your treatment
  • Be an active participant and work with providers to reach health goals
  • Document treatment, symptoms and family history prior to doctor’s appointment
  • Stay a smart health care customer by asking questions and knowing when it is time to switch practices
  • When decisions are made as a team, stick to them to achieve goals

WHAT IS TELEMEDICINE?

By: Dennis Riedmiller, CBC from Riedmiller & Associates

You may have heard of the growing field of Telemedicine. It is simply the use of telecommunication and information technologies in order to provide clinical health care at a distance. Due to advances in technology there are a variety of applications using email, video, smart phones and wireless tools. Telemedicine is not new. Since the days of the telegraph and telephone, telemedicine and medical advice over electronic means is well known. What is different today and starting over forty years ago, not only hospitals and home health agencies, but now employees and their families can communicate directly with a medical doctor, via email, video or cell phone.

The best usage of Telemedicine is for non-emergency or what is called “emergent” care. That would be typically be advice with diabetes and asthma management, head colds, minor burns, insect bites, bronchitis and a whole list of minor ailments.

Why is Telemedicine growing so much? Basically, due to the higher cost of healthcare and the dwindling supply of primary care physicians. The recent Affordable Care Act will increase the number of U.S. citizen which could be over 30 million into a stressed healthcare system. Primary Care physicians are retiring or leaving solo and small group practices and becoming employees of local and regional hospital chains. Hence, lower supply.

The cost of healthcare continues to rise with average doctor visits $120 to $170 and emergency room visits, many unnecessary of $1,400. Many consultants agree 70% of visits can be handled over the phone. Employers are eager to save on cost to reduce unnecessary utilization and with U.S. wages and benefits averages $30.71 per hour, the cost of Telemedicine is only $.04 cents per hour.

As the art of medicine begins to mature from a traditional delivery model to alternative access of care models this will offer innovation and alternatives to delivery of care.

For Third Party Administrators (TPA) this is a real opportunity to help clients reduce costs and add real value to their customers.

For more information about Telemedicine, please contact Dennis Riedmiller of 1-800MD at dennisr@riedmiller.com

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