Most people can’t successfully comparison shop for healthcare

by Ateev Mehrotra MD

Comparison Shopping for Healthcare

As a doctor,  I’m the perfect person to price shop for an operation. But the process went terribly.

 

After three months of using hot compresses to shrink the stye on my daughter’s eyelid, it wasn’t getting any smaller. My daughter is prone to this sort of growth, called a chalazion. This one would have to be removed surgically, like the one she had removed from the same eyelid two years earlier.

But there was one key difference this time around: Like tens of millions of people who get health insurance through their employer, my family was now in a high-deductible health plan. That meant we would have to pay for the entire cost of the surgery out of pocket. Suddenly, the cost of the surgery became very important to our family.

Encouraging patients to price shop for their health care is one reason employers are switching to high-deductible plans. The theory is that patients will compare prices across different doctors or hospitals and choose the lower-priced one, thereby saving themselves (and their employer) money. But in order to shop, you need to be able to see what something costs beforehand. Transparency in health care prices is a goal of President Trump’s health agenda, and is a priority for other politicians as well.

My family had every advantage that newly minted price shoppers could possibly have: We live in Massachusetts, one of the states that have passed price transparency laws to help patients shop for care; I am a physician; my research focuses on consumerism and price transparency, giving me plenty of insider information; and the surgery was minor and not urgent, giving us lots of time to shop around.

How did it go? Terribly. Here’s why:

On the website for our health plan, we muddled our way to its hard-to-find price transparency page. When we finally got there, we didn’t get the information we needed: removing a chalazion is not a common procedure, so it wasn’t listed.

An ophthalmologist would remove the growth. The billing department for the ophthalmologist who evaluated my daughter could tell us only what the doctor’s fee for the surgery would be ($1,007) and didn’t know the fees for the anesthesiologist or the operating room, both of which could be as much as, or more than, the doctor’s fee.

To get a better price estimate, we called our health plan. It asked us to submit a written cost request for the surgeon and the hospital we were considering. Twenty-four days later, we received an estimate of $452, which was both incomplete (it only showed the ophthalmologist’s fee) and incorrect (the health plan mistakenly assumed we were in a different insurance plan).

Other ophthalmologists we called said they would give us a price quote for the surgery only if we brought our daughter in to be evaluated. Each evaluation visit would cost more than $200.

One month into our price-shopping effort, all we knew was that the ophthalmologist’s fee would be in the $452 to $1,007 range, and the total surgery would cost much more. All the while, the red, swollen eyelid on our increasingly miserable middle-schooler was waiting to be treated. So, we decided to go ahead and have the original ophthalmologist do the surgery, even though we had no idea what it would really cost.

In the end, it cost us $1,443, including $556 for the ophthalmologist and $887 for the anesthesiologist and hospital. Despite the challenges, we recognize that we were fortunate — our daughter’s surgery went well and we could afford this unbudgeted expense. Others aren’t so fortunate.

Sadly, my family’s price-shopping experience is the norm in the U.S. My colleagues and I have found that most people can’t successfully shop for care, and that offering people a price transparency website doesn’t help them switch to lower-cost providers and doesn’t decrease health care spending.

Why isn’t price transparency currently working? It’s not that Americans don’t agree with the idea of shopping for health care. Most believe it makes sense and could save money for families and the health care system. Many recognize that there’s a great deal of price variation and believe that health care prices have little relation to quality, a suspicion our research backs up.

What can be done? First, we need to bundle payments to hospitals and surgery centers: a single payment that covers everything related to a procedure or doctor visit. Patients shouldn’t have to navigate the craziness of different bills for the hospital, surgeon, operating room, pathologist, anesthesiologist, and the like.

Click here to read the rest of this article originally published in STAT

 

 

 

JD Power Identifies Decline in Pharmacy Customer Satisfaction Driven by Escalating Prescription Drug Costs

by Michael Johnsen

 

The U.S. pharmacy industry, perennially one of the highest-scoring industries measured by J.D. Power, experienced notable declines in overall customer satisfaction this year, the research firm reported Tuesday.

According to the J.D. Power 2017 U.S. Pharmacy Study, decreases in satisfaction with both brick-and-mortar and mail order pharmacies were driven primarily by declines in satisfaction with cost.

“Pharmacies have historically earned very high marks for customer satisfaction, so any significant year-over-year decline is cause for closer investigation,” stated Rick Johnson, director of the Healthcare Practice at J.D. Power. “Consumer concerns about rising drug prices have likely affected perceptions of the cost for their retail prescriptions. The decrease in satisfaction with cost is the primary drag on overall customer satisfaction, creating a serious challenge for retailers.”

“Pharmacies have historically earned very high marks for customer satisfaction, so any significant year-over-year decline is cause for closer investigation.”

Decreases in satisfaction with brick-and-mortar pharmacies were driven by year-over-year declines in satisfaction with cost, which fell 27 index points to 789 (on a 1,000-point scale), and the in-store experience, a 14-point drop to 851.  Decreases in satisfaction with mail order pharmacies were driven by declines in satisfaction with cost (minus 49 to 787) and the prescription ordering process (minus 15 to 877).

This year’s study measured drug adherence levels across the different pharmacy channels for the first time, and found that 79% of customers who filled prescriptions through a brick-and-mortar pharmacy reported they always were adherent to their medications. This compares with 84% among mail order customers and 74% among specialty pharmacy customers. Customers who discussed a prescription with a pharmacist in a brick-and-mortar pharmacy at the time of pick-up had the highest overall levels of adherence.

Among all channels studied, supermarkets had the highest levels of overall customer satisfaction (859), followed by mail order (853); hospital or clinic (851); chain drug stores (849); specialty pharmacy (842); and mass merchandisers (839).

AmerisourceBergen’s Good Neighbor Pharmacy ranked highest overall among brick-and-mortar chain drug stores with a score of 889.  McKesson’s Health Mart (886) ranked second and Cardinal Health’s The Medicine Shoppe Pharmacy ranked third (879).

Sam’s Club ranked highestoverall among brick-and-mortar mass merchandisers with a score of 874. Fred’s (873) ranked second and Costco (875) ranked third. While CVS Pharmacy at Target placed fifth this year, it had the largest increase in satisfaction of any pharmacy from 2016 (+20).

Brookshire Grocery ranked highest overall among brick-and-mortar supermarkets with a score of 894. H-E-B (893) ranked second and BI-LO (891) ranked third.

Walgreens Specialty Pharmacy ranked highest among specialty pharmacies with a score of 853. BriovaRx (851) ranked second and CVS Specialty/CVS Caremark (840) ranked third.

 

Link to original article posted in Drug Store News