WBUR

Health Plan Charges Up To $1,000 More For ‘High-Cost’ Hospitals

BOSTON — Many of us go to the state’s most expensive hospitals without realizing it. Maybe it’s where you’ve always gone, maybe it’s peace of mind, maybe it’s where you feel you’ll get the best care. But you may soon — if not already — have to pay for that choice.

The state’s largest insurer, Blue Cross Blue Shield of Massachusetts, is out with a plan that charges members more — as much as $1,000 more — when they check-in or have tests at one of 15 hospitals Blue Cross calls “high-cost.”

Would you pay $1,000 more to have an expected normal delivery at Brigham and Women’s Hospital rather than at a hospital in your community? How about $450 more to have a MRI at one of the state’s most expensive hospitals? (You can answer on Facebook or Twitter, too.) We’re asking because that, in a nutshell, is what this story is about. Will much higher co-pays persuade patients to spend less on health care by checking-in to or scheduling tests at cheaper, less-well-known hospitals? Many employers hope the answer is yes.

Examples of co-pays at "higher-cost" hospitals (Courtesy Blue Cross Blue Shield of Massachusetts)

CLICK TO ENLARGE: Examples of co-pays at "higher-cost" hospitals (Courtesy BCBS)

“The more that we can encourage employees to seek lower-cost alternatives that are equally good in quality, that will help address some of the cost issues that we face,” said Rick Lord, president and CEO of the state’s largest employer group, Associated Industries of Massachusetts. He says Blue Cross must make sure patients know that many lower- and higher-cost hospitals have the same quality ratings.

But are business owners ready for angry comments from workers who may be referred to or schedule surgery at Mass General Hospital, for example, without realizing it will cost them $1,000 more?

Lord responds by saying, “Current increases in the cost of health insurance are not sustainable. These products don’t deny people access to those providers. What it does, though, is require them to pay a higher co-pay, so think twice about it before they choose a higher-cost hospital vs. a lower-cost one.”

Blue Cross launched this plan, called “Hospital Choice Cost Share,” for companies with 50 or fewer workers. The insurer says employers who sign on are saving roughly 5.5 percent. That means employers facing a $1,500 increase on a family plan would instead pay $675 more. A vice president of sales at Blue Cross, Larry Croes, says usually, when Blue Cross offers a new type of health insurance, just 1 to 2 percent of businesses try it the first year. But this high co-pay option plan is taking off.

“We’re seeing in the mid-20s adoption rates, right out of the bat,” Croes said. “Yeah, wow, it’s been a very good reception.”

A list of the state's "higher-cost" hospitals (Courtesy Blue Cross Blue Shield of Massachusetts)

CLICK TO ENLARGE: A list of the state's "higher-cost" hospitals (Courtesy Blue Cross Blue Shield)

Croes acknowledges the plan will not sell well in the Berkshires or on Cape Cod, where the main hospitals are on the high-cost list. In Boston, Blue Cross picked the top four high-cost hospitals: While Beth Israel Deaconess has some high charges for tests and procedures, it is not on the high-cost list. Two Partners hospitals, Mass General and Brigham and Women’s are on the list. Partners Network President Tom Lee says this designation is not fair or reasonable.

“If our rates are higher it’s not because our doctors, or are making more money than other people, it’s because we are using those funds to do other things which I think, by and large, society wants us to do,” Lee argued.

Lee says when Partners makes money, on high-end tests for instance, it uses the profit to keep services that lose money afloat, such as mental health, pediatrics and a burn unit. So if Partners’ business on the moneymaking services drops, what happens to those money-losing services?

“We’re not like trying to hold a gun to the baby’s head, you know we would never do that,” Lee said. “But, can you invest in certain programs that aren’t going to make money if your margins in other areas that do make money are being taken away? Of course not, you have to limit those investments.”

Blue Cross is not the only insurer putting pressure on Partners and the other high-cost hospitals to cut costs. The state’s Group Insurance Commission offers insurance that also charges higher — although less dramatic — co-pays for admission to higher-cost hospitals.

Examples of site-of-service cost variations for certain procedures (Courtesy Blue Cross Blue Shield of Massachusetts)

CLICK TO ENLARGE: Examples of site-of-service cost variations for certain procedures (Courtesy BCBS)

Of course there are political dimensions here. Blue Cross spokesman Jay McQuaide says this high co-pay insurance plan is proof that insurers are taking steps without government intervention to control health care costs.

“The private market isn’t just sitting around letting increases go up at double-digits year after year,” McQuaide said. “With this product and others we’re really offering employers a way to get to a more affordable and sustainable position.”

Blue Cross plans to sell this high co-pay product to all employers, not just businesses with 50 or fewer workers, later this year.

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  • Lily

    re Blue Cross….I would not be alive were it not for MGH. Is Blue Cross saying only the wealthy will survive serious illness? This is a replay of Healthsource NH limiting MRI’s 10+ years ago. Limiting such tests caused cancers to go undiscovered/ultimately costing much much more to cure the illness they surpressed. The head of Heathsource NH earned 10 million plus though.

    • Susan

      So what you are saying is unless you go to MGH for a serious illness, you will die! Give me a break. There are many hospitals on the low cost list that are very good hospitals and have the same quality ratings as the high cost hospitals. Also, tests are not being limited with this plan, as you refer to MRIs ten years ago, you just have to choose a lower cost hospital to have them done if you want to save money.

  • JG

    THIS IS RIDICULOUS! Already premiums are increasing every year 12 – 15%, copays are up, deductibles are higher….now this! When are people going to see that this is not sustainable? USA needs to have affordable healthcare for all. It’s becoming a national emergency.

  • David Ofsevit

    Inquiring minds want to know: If Rick Lord at A.I.M. needs hospital care, does he care which hospital he goes to? It’s easy for someone at the top to be condescending to people for whom a $1000 co-pay may be a choice between life and death.

    The whole idea that health care is something you can go shopping for is bogus. Hospitals don’t tell you what things cost, insurance companies have skewed scales where they pay specialists too much and generalists not enough, and people with insurance wind up subsidizing people without it. Blue Cross is part of the problem, not part of the solution.

    • http://pulse.yahoo.com/_LLH7SFRBBDZ54YLFVP6POB6XAI ANNA

      I agree David; health care is not something you ‘shop’ for.

      Coverage is not care. We all have bodies and they all, cradle to grave, need maintenance. Insurance has nothing to do with it. We need single-payer and we need it now. HR 676, Medicare for All, will eliminate the 31 cents on every dollar wasted on private health insurance bureaucracy, the parasitic middlemen that enrich their execs, increase costs for the rest of us and deny or delay care to patients. HR 676 will implement a single-payer system that will capture the savings and deliver comprehensive, high quality health care to everyone….at a savings of $400 billion ANNUALLY. It’s time. No more ‘it’s not politically feasible’ excuses!

      http://www.healthcare-now.org/hr-676/

      http://www.pnhp.org/news/2005/november/1_in_5_health_care_d.php

      • Zbart

        Oh great. the most flawed, fraudulent system in existence for everyone.

      • http://byrondennis.typepad.com/masshealthstats/ Byrondennis

        Anna, will you please stop calling Medicare “single payer.” Clearly you are not on Medicare and do not help the senior citizens who are on it through a volunteer program such as SHINE. A typical Medicare subscriber either has Medicare Advantage — and deals with one of the “parasitic middlemen” you condemn, not the government — or a government/large-company pension plan or deals with up to five of what you call “parasitic middlemen.” Medicare Advantage is being phased out by the 2010 Patient Protection and Affordable Care Act and the government/large-company pension plans are failing so evenutally all Medicare subscribers will be dealing with multiple insurers.

        If you feel strongly about single payer, make a reasonable case for it (e.g., don’t claim 31% overhead in h/c insurance). You do not appear to be familiar with Massachusetts. Less than 10 cents on the dollar is spent on administration by the Massachusetts non-profit health insurers (see Department of Healthcare Financ and Policy quarterly reports). Some of that is for quality control. Over 90 cents on the dollar goes to providers.

  • msophelia

    one thing i took from hearing the story on the radio this morning is that BCBS would like to push patients to smaller/less expensive hospitals. all well and good, as we sometimes overlook our local resources – but what if the only hospital you have access to is on the high cost list? i have family on the Cape, and CCH is it for them. if they were to end up under the high co-pay system, they would effectively be penalized for not being able to get to another hospital. while i understand wanting to contain costs, this doesn’t seem fair to the patient.

  • nancy

    yes, i would pay more for SOME high-cost hospitals. where i live, some of the hospitals are considered a real risk. however, some of the high-cost hospitals have not done well by me either.

  • nancy

    why doesn’t massachusetts standardize costs like some other states? then competition would be based on quality of service. my recent experience for identical mri’s has shown a difference of close to$8,000 between facilities. this is obscene.

  • South Shore skeptic

    This does seem unfair. We’re on the South Shore, and South Shore Hospital is always rated excellent for quality. Can’t that be good for the bottom line, as well as for patients? South Shore Hospital is a godsend to people in Southeastern Massachusetts who don’t want to have to slog up to Boston for excellent medical care. But not everyone can afford these co-pays.

    I think the grid showing the various services should be much more extensive, and should also show some sort of quality rating next to each cost. More transparency is always a good thing, and certainly higher cost does not necessarily equal better quality. But procedure cost is only part of the picture. What about follow-up? What about quality/success rate?

    (An anecdote–a friend was in Boston Medical Center for surgery, but it kept getting postponed because emergency surgeries were taking his slot…he was told “this is a trauma hospital.” How expensive were the extra days he remained in the hospital waiting for repeatedly postponed surgery? I can’t imagine his case is a first, either. Is anyone looking at length of stay?)

  • sue

    I simply can’t afford to pay more. I have been a patient at South Shore Hospital many times and all my doctors are affiliated. If I have to change doctors in order to utilize a not “high cost” hospital I will lose the benefit of relationship and history, which in my experience are essential to quality and cost efficient health care.

  • MC

    The mid 20% adoption rate is very likely due to the fact that the default renewal option for groups that are going through their renewals include this new Hospital Choice Cost Share (HCCS) rider. BCBSMA generates the renewals with this HCCS rider imbedded into it and it is up to the employer to opt out of it (if they even know to ask). I don’t think that many of these employer groups/individuals understand what they have purchased and members will only truly understand what they have once they actually have to use the new plan and happen to go to one of the “higher cost” facilities.

    How about a follow-up article in 6 or 9 months after people have started to incur claims and then get blindsided by the additional financial “penalities”?

  • Bob

    One of the alleged goals of health care reform and the insurance companies is to establish a relationship with your doctor and to have preventative measures taken to keep you healthy.

    A Doctor must have privileges with a hospital in order to work in the hospital. If your Dr. has privileges in the “high cost” hospital. Your only choice is to spend the extra $1000 or to find a new doctor.

    This just reinforces my dislike for health insurance companies and “big health”

  • Mitzi

    If Ralph Torre head of St. Elizabeth’s took his wife to MGH for care, quality is not the same at all hospitals. How do you measure quality meaningfully?

    • Zbart

      Quality at MGH for Ralph is probably different than for you:)

  • Skeptic

    So what is next…we will have to pay $1,000 annually to Starbucks for buying coffee there?

  • Paul

    To Bob: Your scenario is not entirely accurate. I recently had to get an MRI. My doctor referred me to the hospital where he practices, but I declined and had the referral transferred to another independent clinic. This was possible BECAUSE I have a relationship with my doctor, not despite it.

  • http://pulse.yahoo.com/_LLH7SFRBBDZ54YLFVP6POB6XAI ANNA

    ” A vice president of sales at Blue Cross, Larry Croes, says usually, when Blue Cross offers a new type of health insurance, just 1 to 2 percent of businesses try it the first year. But this high co-pay option plan is taking off.

    “We’re seeing in the mid-20s adoption rates, right out of the bat,” Croes said. “Yeah, wow, it’s been a very good reception.””

    Nice sales pitch, Larry. Yeah, wow.

  • Sev

    I live and work in Boston and all my doctors are at MGH because this is the most convenient hospital for me – I can walk to it. I have seen my doctors for 10 years now and I wouldn’t be able to afford an extra fee, especially up to $1000 for a procedure. This plan doesn’t take into account the personal relationships we have with our doctors, which is a fundamental basis to health care. This is absurd. How much more abuse do we need to take from insurance companies?

  • Karen

    Yes, because I have always gone to BWH. I have had three successful surgeries there, my doctors are there. This is just one more example of how insurance companies control health care and intrude into our long-standing relationships with our doctors. When one lives in downtown Boston, BWH and Mass General ARE our community hospitals!

  • David from Lowell

    I work for a small company that is thankfully lucky to be able to offer health insurance. The owners met with employees and showed us the increased costs, and the reduced costs of this new plan. Basically, if not for this new plan, we wouldn’t have been able to keep our health insurance. We had an insurance rep go over the plan ahead of time, and we found out that where we are (Merrimack Valley), most of our doctors and hospitals were in the low-cost pool, and they still deliver excellent care. While this plan may not be for everyone (especially those where there are only high-cost tier hospitals), it allowed us to keep our coverage. Maybe it’s because we are a small company and have a direct, personal relationship to our bosses, but this didn’t feel like something imposed, but rather something collectively decided upon.

    • unbelievable

      David, this year you almost lost your insurance while Blue Cross profits increased. You agreed to restricted care so Blue Cross could make additional money. How does that not feel imposed?

      • Zbart

        No, he agreed to a restricted plan so THE DOCTORS at Partners would not make more. Did you not read Martha coakley’s report. It is not the insurers you guys, it is the doctors and hospitals raising their rates.

        please read more than the comments here. you’ll be informed!

        • Lauraj617

          Doctors are not the only costs related to healthcare. There are many more MDs at Partners not making nearly what you would think if there was a comprehensive review of their responsibilties vs their salaries. Why are networks doing television shows aobut Johns Hopkins and BWH/MGH/Children’s, simply because there is a difference. Wait a few years, patients begin heading to the hospitals where they do not have to pay “extra”. Those instituations begin to grow, which means adding ORs, beds, nursing, supplies, support staff, drugs, equipment, security, phones, computers, and yes, physicians. What happens, they raise their costs to cover their expenses and so on and so on.
          And how about research, where are the new procedures and treatments being developed. You can’t just go anywhere to have a heart transplant, lung transplant, face transplant.

          I am sure the AG knows the costs of smoking-related illness to the healthcare system. Where’s the out-cry to ban tobacco products. And how much do folks spend on tobacco annually?

          I find it interesting that there is always a story aobut Partners when literally the Brigham and MGH are in the business of saving lives. We pay how much for an automobile? That lasts how long? How much do the people of this country spend gambling? How much does Big Papi make? How much does Ben Affleck? You k now MassHealth and Free Care patients can go to BWH & MGH.

          BCBS is not your friend. They are a business and they have an agenda and the agenda is to save themselves money. They are using a tough economy to push their own agenda. This plan is actually just shifting costs.

          The insurers, including the federal government, will eventually push the best and brightest minds completly out of healthcare.

    • Craiga

      Did they say if you collectively agree then we won’t charge you another grand if you go to a different hospital?

      You bought the sand they were selling, and there was nothing else for sale.

      • David from Lowell

        I don’t know about “buying sand”, but I’m thankful to still have a job and still have health insurance. And the “they” you were referring to is not some abstract boogey man; it’s my employer, with whom I’ve had a good relationship for years, who is also on this new plan. There’s no one offering me single-payer health insurance (which I would gladly take if there were), but I can still take my kids to the doctor when needed, which is no small thing, no “sand”. Many of the sky is falling complaints from this comment page strike me as surprising, and from an entitled perspective. People all over the world and all over this country can’t afford to take their kids to the doctor, and to be able to do that, I’m willing to have to think about my health plan a little bit. All of a sudden, when the suburban self-segregationists are affected by a little extra detail, it’s the end of the world.

  • Still Alive

    Our family just had two in-patient hospital experiences, one at MGH and one at Emerson (which MUST be on the loooowwww cost list – or should be if it is not). The on-floor nursing was not comparable between the two. At Emerson they seemed to have a (relatively loud) party every night, seemed to answer the patient’s buzzer only when they felt like it (typical wait was 10-15 minutes), etc. At MGH, the nursing staff were always there and always attentive. However, the MGH patient had to stay an extra day because the time slot for the procedure kept being pre-empted by higher priority emergencies.

    Obviously, this is anecdotal. We did not survey every ward, just one each. But the relative experiences suggest that one gets what one pays for – and the Emerson patient could well have died while awaiting a response to the buzzer. That suggests that paying more, just to stay alive, is probably worth it.

    There has to be an objective way of measuring relative care as well as just comparison of costs

  • Flodur2

    Riding in a Cadillac costs more than riding in a Chevy but both get you to the same place. If you insist on taking the Caddy, you’ll have to pay extra for it. Doesn’t that seem fair or logical? Why blame the health care insurer?

    • David Ofsevit

      This is a false equivalence. Years ago, a relative was dying at a small hospital on the North Shore of heart disease, and the docs there admitted they didn’t know what else to do. His family put him in an ambulance, took him to MGH, got a top expert on the case, and he lived another 15 years. That wasn’t Cadillac:Chevy, it was Ferrari:little red wagon (with the wheels fallen off).

      • Zbart

        Very interesting. How much did MGH pay you to post this. I guess a lot of your folks makin good dough there:)

  • Patfleming1

    I absolutely would pay more for these ‘first’ class hospitals. I now go to MGH for all of my care and my family’s care. We got there because no one could diagnose my daughter—finally got to MGH and after years she was diagnosed with a rare non-inherited genetic syndrome. My ssecound daughter went to local doctors/hospitals for 5 months with extreme pain—she was consistently told it was a virus that would work itself out–when I finally got her to go to MGH–within hours she was diagnosed with lymphoma—treatment started within hours after that.

  • Wendy Livingston

    I chose my particular health plan because it allows access to some of the best hospitals in the world. I believe, that since I live within 25 miles of most of the hospitals on your list, I should be able to have access to care at these hospitals. I do not need these hospitals for routine care but sometimes diagnosis depends on a world view of care, not a local view. I hope that somehow, a compromise can be found that would allow care to be obtained at the best possible hospital for the disease.

  • Sadechri

    The higher costs are driven by FREE care for people without insurance. Of cours this state says everyone must get insurance —- but doesn’t enforce it by telling hospitals to turn those people away. The primary offenders are all the ILLEGALS. Wake up Americans.

    • Elisaanddavid

      I am one American who is very much awake, and I reject your statement that it is “all the ILLEGALS” who are to blame for the national crisis we find ourselves in today. What an abhorrent over simplification, not to mention self-revealing, remark, Sadechri.

    • Anonymous

      Have some facts to back that up, Sadechri?
      I worked with many people and know and know of many others who have health insurance and primary care doctors who still think that the appropriate action is to wait for a weekend and run to the ED.
      People insist on test after test and pill upon pill because they have health insurance and it
      “doesn’t cost me anything”. Those short sighted people drive up care just as much as anyone else does, IMHO.

    • Craiga

      I bet you consider yourself a moral person. Then you want to command hospitals to kick people to the curb if they don’t have insurance or a pile of cash in hand. This isn’t what our country is about. I find it odd how so many “religious” people have the same view.

  • Sadechri

    The higher costs are driven by FREE care for people without insurance. Of cours this state says everyone must get insurance —- but doesn’t enforce it by telling hospitals to turn those people away. The primary offenders are all the ILLEGALS. Wake up Americans.

  • John

    Too many people in the U.S. confuse “healthcare insurance” with “healthcare.” In one, the money is paid to a middleman regardless of whether services are rendered; and in the other, money is paid for services. I would gladly pay for a national-government-run healthcare delivery system as efficient as Medicare (the U.S. government’s current healthcare delivery system for those over 65 years of age and which is 95% efficient) rather than the $14,800 annually that I, as a small business owner, pay to a private insurer in Massachusetts for my wife and I to have mediocre insurance coverage.

    Mandatory healthcare INSURANCE is NOT the answer. It merely guarantees that INSURERS will be paid. Rather, guaranteed health CARE, paid by every American through taxes, is the answer.

    The only way to reduce costs equitably is to level the playing field, by getting the rich, the poor and the middle class; ordinary citizens and elected officials ‒ everybody ‒ on the same decent plan subject to the same rules, and paying and being paid the same amounts. You want more or better care than than the basic good-quality care provided? You pay more for it through a health insurer. Only then can we have a meaningful, much needed dialog about costs and cost control. Anything else only kicks the can to the next group or generation and postpones the inevitable.

    • http://byrondennis.typepad.com/masshealthstats/ Byrondennis

      John, I’m also a small businessperson paying a lot for my wife’s and my coverage except that we’re about to go on Medicare. Have you attended any of the seminars yet? If not, you’re in for a surprise.

      You say:

      “I would gladly pay for a national-government-run healthcare delivery system as efficient as Medicare.”

      But Medicare really does not work that way.

      You get A for “free,” hospitalization, in return for the tens of thousands you’ve contributed over your working life. Then you pay $116 a month (this year-goes up as SSA goes up) for B, doctors, etc.. But there’s all kinds of co-pays, deductibles and caps in both A and B so you’ll want to get a Medigap policy from one of the healthcare insurers you’re dissing in your comment above. That’s another $200 plus/minus a month. Oh do you want prescription coverage: that’s Part D–anywhere from $35 to $200 a month more–probably from another insurer (unless you hit the formulary lottery). This is where the doughnut hole comes in but we’ll let that go for the sake of the length of this comment. How about vision or dental coverage? Then you probably need one or two additional insurers. The original Medicare guys must have figured we’d all be in dentures and be macular degenerate by the time we turned 65.

      Given what you say you pay for you and your wife, my guess is that you now get all of the above from one insurer. On Medicare (how’s this for efficiency?) you now deal with three to five insurers!

      There is another option, called Part C, Medicare Advantage, that wraps all of the above in one package. It is probably like your current coverage except most are typical capitated HMOs, which have many of the restrictions you’re commenting on above. My wife and I are probably getting one of those for a few years for the savings, convenience and the “efficiency.” But I don’t expect it to last long because the federal Patient Protection and Affordable Care Act (PPACA) is going to take a quarter trillion out of the Meidcare Advantage program, and give it to the non-elderly in subsidies to buy insurance. Kind of like Romneycare supposedly took the Free Care Pool money and gave it out in subsidies through the Authority. Harvard has already dropped its Medicare Advantage program and the rest will surely follow suit as the PPACA kicks in in 2015 or whenever. BC/BS, etc. still get their money but the elderly go back to the A/B/Medigap/D/vision/dental dance I described above.

      As for efficiency, everyone on Medicare tells me they get about 500 pages of correspondence from the government annually… unless they get sick

      – Dennis

      • John

        I have dealth with Medicare in the care of my mother and even in its current state I have found it to be reasonably efficient and equally if not more fair than our current single insurer. That said, you raise valid and important points, many of which are symptomatic of our straddling multiple systems. Regardless, if everyone were on the same system there would be great incentive to making it work. Other countries achieve better overall health delivery results than the U.S. currently achieves and at less than half the cost per person. Surely we in the U.S. can figure out how to deliver reasonable health care to all at a more reasonable cost. How does that great American saying go? “United we stand…”

        • http://byrondennis.typepad.com/masshealthstats/ Byrondennis

          OK so you really don’t care about Medicare’s inefficiency and mediocrity as I described it in detail. In what way is Medicare (however your Mother gets it) “more fair” than your “current single insurer?”

          Please be more honest and don’t pretend that Medicare is either single payer or efficient. You just want government run healthcare insurance (or even healthcare delivery, I can’t tell) for whatever reason. That’s OK but don’t equate your ideology with Medicare.

    • http://pulse.yahoo.com/_LLH7SFRBBDZ54YLFVP6POB6XAI ANNA

      John is right! Coverage is not care. We all have bodies and they all, cradle to grave, need maintenance. Insurance has nothing to do with it. We need single-payer and we need it now. HR 676, Medicare for All, will eliminate the 31 cents on every dollar wasted on private health insurance bureaucracy, the parasitic middlemen that enrich their execs, increase costs for the rest of us and deny or delay care to patients. HR 676 will implement a single-payer system that will capture the savings and deliver comprehensive, high quality health care to everyone….at a savings of $400 billion ANNUALLY. It’s time. No more ‘it’s not politically feasible’ excuses!

      http://www.healthcare-now.org/hr-676/

      http://www.pnhp.org/news/2005/november/1_in_5_health_care_d.php

  • Michael

    So what Dr. Lee is admitting (no news really) is that charges have little to do with costs. Like it or not, people are tired of being charged more than the services they need are worth so that others can consume at a subsidized price.

  • Michael

    So what Dr. Lee is admitting (no news really) is that charges have little to do with costs. Like it or not, people are tired of being charged more than the services they need are worth so that others can consume at a subsidized price.

  • http://twitter.com/drphilxr Philip Kousoubris

    So many good comments from patients! Love it, as a MA doc, I’m as frustrated as the rest (and pay a lot for family insurance too). Healthcare costs are rising not because of healthcare workers, and you know it!

    It’s the ‘unseen hand’ (lobbyists first, then powerbrokers / insurers/ equipment manufacturing corps / big pharma / etc etc) who are driving costs skyhigh along with all the loopholes mentioned. If the people are so well informed, there’s hope!

  • http://twitter.com/drphilxr Philip Kousoubris

    So many good comments from patients! Love it, as a MA doc, I’m as frustrated as the rest (and pay a lot for family insurance too). Healthcare costs are rising not because of healthcare workers, and you know it!

    It’s the ‘unseen hand’ (lobbyists first, then powerbrokers / insurers/ equipment manufacturing corps / big pharma / etc etc) who are driving costs skyhigh along with all the loopholes mentioned. If the people are so well informed, there’s hope!

  • ginger

    I will always pay more where I know I can get the better service; that includes medical care. The expensive area Boston Hospitals are not always the best for everything, like any other professional service. If I think a physician is smart, can educate me re: their healing plan, is respectful and straight-forward, and they are recommended by people I trust, I’ll pay more.

  • Buggs26

    The only step I can see that private industry is taking to control health care costs is to pass that cost on to the consumer. What kind of profit margins are we talking about here, either in the executive offices of the hospitals or the insurance companies? Exactly how much is one CEO, COO, CFO etc., worth, anyway?

  • Jim

    Yes I would pay but I shouldn’t have to. Especially if the hospitals with the higher cost have better outcome, either demonstrated or believed by the public.

    • Anonymous

      Jim
      “believed by the public” means propaganda, doesn’t it?
      Many moons ago I moved to Nbpt. in order to access their supposed exemplary school systems. I paid greater costs for years for the same education I could get in any of the surrounding cities or towns.
      Having a good rep means nothing in the real world.

  • Terralin

    For myself, I would just not get the MRI or whatever — my husband, however, is a heart patient who has to be monitored monthly and what is annoying is that we live within close walking distance to MGH which has been our hospital, where our primary care physicians have been for years. Why when we are “older yet not old enough for medicare” and do not drive should we have to travel to somewhere out of our neighbourhood to get treatment? Doctors at MGH SAVED HIS LIFE — this insurance modification plan is just another reason I wish medicare would be available to all…. or, maybe if this private insurer thing is so wonderful, let us cross state lines for a better deal….. and, BID is cheaper? HA — I sincerely doubt that, their hospital rooms are like country club resorts compared to what is at MGH….

  • dkin02025

    Sure looks like a tiered system where the wealthy will get better care…

  • Erin O’Connor

    Who decides which lower-cost hospitals do “as good of a job” with procedures? Qualified medical specialists, or unqualified insurance company staff? This is a slippery slope that promises to widen the gap between rich and poor regarding the quality of care they receive when they are ill or injured.

    • TC

      Erin, how do you know that the “insurance companies” are unqualified to provide information on Qaulity Care and who’s doing a “good job”. These companies employ doctors and nurse, as well as academics that research delivery of care and best practices. Have you ever heard of Disparities in Care or Variations in Practicve Patterns? These are not topics the insurance companies made up. Rather they are raising a discussion becuase the qualified medical specialists don’t want to be questioned on how they deliver care.

      • Eoconnor

        TC, I am fully aware that there are medical personnel working for insurance companies–I talk regularly with a nurse at one b/c my son is a type 1 diabetic. However, it is often lawyers and policy writers who “translate” medical advice (which is not always representative of the variety or even majority of experts within a particular field) into policy/practice. Further, that gets put into codes that are constricting and often have the result of denying people coverage for best practices of care. In short: often the medical experts in these companies are far removed from writing policy or paying for care. At least, that’s been my experience over the years, in some ways that I find quite shocking with my son’s chronic medical needs. Thus, I am concerned about how this new policy will work in practice and whether all will truly receive equal care.

  • JASM

    Economic theories of a competitive marketplace only work if there is transparancy regarding costs. I don’t think most people consider costs when making healthcare decisions because they have no information on the cost. There are way too many permutations of insurance, and too much money siphoned off to the middleman.

    A single provider model with clearly explained patient fees would add much needed simplicity, and would allow medical professionals to focus on providing medical care, instead of insurance paperwork.

  • Craiga

    This is a good idea with the exception that one needs to have a PhD in your insurance rules to know such things. All the complicated ways you can get hit with a larger bill are getting worse. I challenge anyone to actually read all the fine print in their health plan, and also realize how much your plan costs you+employer per year. People seem to have this idea that if their employer pays 6,000 a year for your health plan that money is somehow free for the employer. How about you get that in cash instead, then you’d realize how expensive your insurance is.

    I wouldn’t shed a tear if the insurance industry disappeared.

  • audrey

    Two years ago at a well-known local city hospital, which is not on the high-cost list, I was charged $1500.00 for a cut thumb!

    If it had only stopped bleeding, it would have cost me the price of antibiotic, gauze pads and tape, all of which are in our medicine cabinet.

    There was nothing unusual about the small, one-inch cut except the bleeding. Nothing broken, no severed veins, no damaged muscles, or anything. The cut was clean, smooth and clear, having been made by a clean, sharp knife I accidentally bumped hard when I lost my balance in the kitchen. I would never have gone to the ER, but the bleeding was still heavy after four hours, in spite of ice and proper firm bandaging. It was a weekend, so no clinics or doctor’s offices were open. I was still reluctant, but I finally went on the advice of a “phone nurse,” and my sister & mother, both RNs, agreed. I was driven to the hospital late at night.

    We didn’t wait long in the empty waiting room. However, the ER was another story. The only thing the hospital personnel did to stop the bleeding was to make us wait a total of eight hours in an absolutely empty ER, which allowed for coagulation. The place was so quiet and unpeopled that we felt as if we were in the Twilight Zone. Perhaps the entire staff had gone away for the weekend. When the actual work was performed the bleeding had almost stopped by itself. The job was done badly, using glue on the wide hole instead of stitches that would have held together the two sides of the cut. The cut healed with a bump in the middle where stitches would have prevented it.

    A few hospital personnel spent a few minutes each with me — perhaps a total of one half hour — and used hardly any supplies. My insurance company, which usually brings down the cost, paid the bill IN FULL and charged me the usual $50 co-pay.

    WHO drives up the costs?

  • David

    A new way to ration health care. This is the reason we need to have the comprehensive health care reform move forward. I would love to know the value of uncompensated care provided by the “high cost hospitals” relative to their overall revenue.

  • Leafytree600

    So, basically, policies like this new Blue Cross Blue Shield one will create pressure on the healthcare system to provide services based on what is ‘money making’ rather than what supports the health of the community.

    An extreme scenario, but:
    It’s okay. There are people who, no matter what, will have the money to fly to another location where others with like assets can congregate for their healthcare, perhaps on an island somewhere off-shore, where, perhaps, they could also skip contributing to the tax pool.

    • Leafytree600

      and, of course, I’m talking both about having the ability and the will to do that. Not that these go hand in hand.

  • Bostonhardrock

    I’m so sick of this system. After losing my job and health insurance I got really sick. Not wanting to go to a hospital I could not afford, I tried to treat myself with over the counter stuff, but all I did was make things worse. By the time I started going in and out of emergency rooms it was obvious my intestine was blocked. My soon to be ex-wife begged her employer and her Insurance Co. to cover me retroactively, which they did, but all the doctors want to do is treat me with over the counter meds. They act as if they are in complete denial. I know I need surgery, but it seems to be out of the question. They won’t even acknowledge the facts. Had I had options when I first got sick, none of this would have happened. Now I’m forced to leave the State, move in with relatives and seek government help. Had I been treated aggresively, I could have gotten better and resumed life as a productive member of society. Instead, now I must become another government leach.

    Here’s to Massachussets health care system.

    Cheers

  • Dish911

    As this plan is in effect, I had care for my son performed at the local hospital, I did know at the time that there was a plan in action to charge me more for service at the local hospital I had been to the same doctor with my son several times and several operations, I could not just change doctors and now I stand to loose my good credit standing and and my house. I have been out of work for three years and was paying my own health insurance and could not keep up with the premiums even with assistance from the state. When the state paid for the plan in full we were put on the blue cross blue shield plan and then thats when the bills trippled for out of pocket expence copays  and extra deductibles that we had to find out by asking questions not by information that was understanable to the avarege person.

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