The Checkout

Orbitz for Docs? Not Yet.

In a few weeks, employees at The Washington Post Co. get to sign up for health care for the following year. And like a lot of companies and the federal government, The Post has embraced "consumer-driven" health care to help keep health care costs down.

Consumer-driven health care generally involves tax-sheltered accounts that consumers draw upon to pay for certain medical expenses. In some cases, consumers put money into the accounts. In other cases, employers kick in money as well. The idea is if consumers have to decide how to spend their health care dollars, they will spend more wisely.

Until recently, consumers haven't had much to base their choices on because they didn't know how much anything cost until they received their Explanation of Benefits. The latest wrinkle in consumer-driven health care is giving consumers access to pricing and quality of care information to let them shop for doctors, hospitals and procedures much the way they would surf the Web for a digital camera or a vacation package.

Since late August, Aetna members in the Washington area have been able to compare rates and quality of care ratings for doctors at its Web site.

As an Aetna member staring down the possibility of being forced to trade my cushy PPO plan for an HMO or a health savings account just as I'm about to have a kid, I figured I'd give it a whirl.

Under The Post's new plan, the company will put $1,000 in our health savings accounts each year. We don't pay a cent--no deductible or co-pay--for medical or prescription drug costs until we run through the $1,000. Preventive treatments and visits are covered by the plan and don't come out of the $1,000. Once I spend $1,000, I pay 100 percent of my medical and drug costs until I hit an additional $1000, after which I pay 10 percent of my costs if I go in-network and 30 percent if I go out of network.

I decided to search the Aetna site for an obstetrician. I go to a large OB-GYN practice in town, but I'm not 100 percent happy with it. During my last visit, face time with a doctor and having my blood drawn took no more than 10 minutes. But because I had to wait so long at each step of the way, I didn't get back to work for an hour and a half. And it's a five-minute walk from my office.

Here I discovered the down side of Aetna's site--and many similar sites at this point. Useful data on health care quality is pretty much a patchwork, with more complete stats for hospitals than individual doctors, and for common procedures such as heart surgery than for less common ones such as acupuncture. That's partly because not every specialty has standards and not every doctor or hospital has agreed to such scrutiny.

As January W. Payne reported in The Post in August, Aetna has data for 12 specialties, such as cardiology, neurology and plastic surgery, though it allows you to search for practitioners outside those areas. Also, only some doctors, identified with a blue star, have agreed to take part in Aetna's quality rating system.

I compared my current practice to an OB a friend had recommended and got some useful info, just not a lot of it. Both practices met the threshold for three major criteria: volume, clinical quality and efficiency. Volume means the doctor saw at least 20 Aetna members over the past two years. Quality is based on criteria such as whether patients had been readmitted to the hospital within 30 days for the same problem. Efficiency is based on how much the doctor spent to treat a particular condition compared with his or her peers.

Both my current practice and the one I was considering had a check mark in a box next to each category, which means they meet basic competency standards. Good to know. As for the bedside manner-type concerns I had, the site allows you to review survey results for doctors, which could tell me whether they had racked up any complaints. But there were no survey results for either.

The up side for the future is the availability of health care quality information is likely to get better with time. It's still the early days for Aetna's site, which is currently available in only a few select markets nationwide, Aetna spokesman Walt Cherniak said. And an objective approach is more useful for consumers than Best Doctor's lists that are usually based on more subjective measures.

Have you had better luck shopping around for health care? Have you ever had to do it during a serious health emergency?

By Annys Shin |  October 10, 2006; 7:30 AM ET Consumer News
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Comments

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Ms Shin: So you are going to spend your tax free HSA funds that are growing without taxation. I suppose you are the type of person that would spend your taxed 401k funds, that are growing for retirement, if 401k funds had the freedom of early withdrawals like an HSA. I have had my HSA since the very first day of freedom, 1/1/97, back when it was called an MSA. I don't take withdrawals but I do keep my Qualify Medical Expeses (QME) proof of purchases in a file to be withdrawn in the future.

Welcome to the land of tax freedom. Glad you could make it. Your HSA effective date will be 10 years to the day, later than mine. I'm not saying you are lethargic, you were just uninformed.

The best tax cut is NO TAXES and it's TIME for your HSA.

America's 1st HSA sales team is online at www.save101.com

Posted by: Ronald Greiner | October 10, 2006 8:58 AM

Perhaps it would be valuable to know what the doctors think of their "standing" with these so called quality measures. It sounds like your group meets it, but you still had an unsatisfacory encounter. Maybe you could get a better result ie. you get better care at the practice you have invested time in already by making an appointment to share your interpretation of their qualiy findings vs your experience. You have to look at your sunk cost in terms of your time already. If you think the relationship is worth investing in do so. If not then you should probably think about shopping around. Good medical care is about more than beating by price. Not all doctors are the same, and I am worried that "you get what you paid for" will drift into medicine. It costs money to produce a good experience. Let them know if they are doing it or not. They will care. Partner with your doctor for benefit to you, the physician , and the next patient.

Thanks for your insights

Posted by: BER | October 10, 2006 9:59 AM

Our Firm gave us two choices for medical insurance. They also pay a certain amount toward coverage. We could choose a PPO without dental, which uses up the entire alloted amount, or an HMO which uses less of the alloted amount and you can get dental with the remainder. So, I chose the HMO. Stupid me!

With the HMO, your Primary Care physician has to refer you to other doctors for treatment. My doctor's office is very busy and I'm lucky if I get to see him for 5 minutes (after a 45 minute wait in the waiting room every single time). One time I wanted to see a dermatologist -- the only one in the County. Had to make an appointment with my PC doctor for the referral slip, when make an appointment with the dermatologist. He had NOTHING AVAILABLE for 5 months. Totally booked up, so I gave up on that. Then one morning I fell on the way to work, broke a small bone in my hand. I went to the ER after work, they X-rayed it then referred me to an orthopedic doctor to see within the next 2-3 days. When I called the orthopedic doctor's office, they refused to see me because the ER doctor, not my PC doctor, had referred me. I would have had to wait another 3 weeks to see my PC doctor. I just didn't go for a follow-up appointment.

So my decision now is should I change to a PPO and give up dental, or stay with this crappy system of the HMO and include dental? You honestly have to jump through hoops to get good medical care. I really feel sorry for the elderly and poor who can't afford coverage. I have very good teeth, only need cleaning and check-up every six months. Haven't had a cavity since 1975.

Posted by: Southern Maryland | October 10, 2006 10:31 AM

Congratulations on entering the world of consumer-driven health care. First, a slight correction to one of your comments: HSAs are usually tied to a PPO plan, so while you might change some details of your health plan, you are in no way being stuck in an HMO." For the most part, the new HSA plan will work the same as your PPO did - but you will have an incentive to be a wise consumer rather than treat your health plan like an "all-you-can-eat buffet". For instance, I can use my HSA funds for over-the-counter drugs or dental co-payments (Try that with an HMO!).

Studies have shown CDHC plans lower the cost of health care and improve the quality. Patients with chronic conditions become better managers of their own health, and have shown to actually improve their overall health status under consumer-driven plans. Imagine the positive effects to patients who are generally healthy.

Don't forget you can add to your HSA throughout the year. After the Post deposits their contribution, you can make further contributions until you hit your deductible. This allows you to save pre-tax money for future health needs. If you don't use the money this year, it rolls over into next year, and will be there when you, or your family, needs it.

It's true there is not as much provider information available as we would like. One of the benefits of the spread of CDHC is that as more patients demand the information, health care practitioners will have to provide it.

Our website provides a wealth of information about CDHC plans: http://cdhc.ncpa.org
Feel free to visit for the latest news and commentary on consumer-driven plans and health savings accounts.

Devon Herrick
Senior Fellow
National Center for Policy Analysis

Posted by: Devon Herrick | October 10, 2006 10:47 AM

Can we maybe receive comments from people who aren't shills for the health care industry?

Posted by: A reader! | October 10, 2006 11:20 AM

Buying an individual HSA plan (seperate from the group) would save even more money

www.HSAsale.com

Posted by: Tom Rogala | October 10, 2006 11:27 AM

I just went though the experience of trying to find a therapist to work with some issues. I went to the Magellan website, which is who provides the mental health benefit for my Carefirst BlueChoice plan. I used their search and got about 50 names in my home and work zipcodes. 50 phone calls later I still didn't have an appointment and had only spoken to one receptionist. After four days, I had heard from about 12 people, most of who weren't accepting new patients or were no longer practicing.

I finally made an appointment to talk to someone.

Now imagine if I was severely depressed -- would I have been able to do this, or would I have given up and become more depressed?

Posted by: alexva | October 10, 2006 1:56 PM

"consumer-driven health care" is simply doublespeak for "patient-paid health care"

It's simply not fair of you to get free health care without having to "invest" in it. Basically, you don't deserve it.

Real wages are flat and health care costs for the average cubicle slave are going up. Mr. Herrick, how is executive compensation doing this year?

Posted by: DCB | October 10, 2006 6:05 PM

Consumer directed healthcare is all about the movement from a THREE PAYER system to a two payer system - the shifting of dollars from the Wall Street insurance companies and their stock holders to Main street consumers. Once consumers control the flow and participate DIRECTLY (via health savings accounts) in the efficient use of healthcare dollars, doctors and hospitals will finally take price transparency seriously.

Currently doctors have allowed the insurance companies to gain the consumers confidence by providing multiple cost models. Cashdoctor.com was the first website in the United States to create and online medical portal allowing doctors and hospitals to freely post their OWN CASH prices for the insured and the UNINSURED to access 24/7. Our site has been available to the healthcare industry for THREE years, yet doctors and hospitals have YET to move to a voluntary posting of prices for all consumers to access.

Doctors and Hospitals must voluntarily move forward to provide pricing where ever possible and in as many places as possible so as to gain the consumers confidence and support.

Doctors have missed the opportunity to reach out to consumers who have the option to choose a consumer directed healthcare plan in 2007 by not providing an accessible listing of fees on the internet. Cashdoctor.com provides these services FREE TO doctors hospitals, healthcare professionals and consumers at our website www.CashDoctor.com. If doctors and hospitals want to make a difference for 2008, they need to start now by showing consumers the ACTUAL cost of healthcare on the internet - 24/7.

Rob Stehlin
Founder Cashdoctor.com

Posted by: Rob Stehlin - Founder Cashdoctor.com | October 11, 2006 9:32 AM

this is where you need to be proactive. Make the appt with the specialist, then call your PCP, and tell them when the appt is scheduled. As long as you have had good communications with the practice, and have been seen by them within the past 9 - 12 months, they will hand off the referral.

Now, for me that was problematic. I had not been sick for more than a year, and I needed a referral. I had made my appt. with the specialist. My PCP told me they were booked, and I would need to be seen by someone. So I just showed up as close to opening time as I could, explained to them that my appointment was for late that morning, and anyone could evaluate my issue -- in the waiting room if that was more convenient. I was in & out of there in 30 minutes!

Keep in mind you need to be pleasant, and flexible. But if your PCP cannot help you, they would just as soon not book the physician's time, and handle the referral.

You have to do your part as well -- maintain good communication, realize it's a place of business, go to the doctor informed, ask questions about your treatment and meds., and let them know that you understand their limitations so they might be able to help with suggestions.

Nope, I'm not involved in medicine, I'm just an educated consumer before I spend my or my insurer's money!

Posted by: to frustrated roken handed | October 11, 2006 11:58 AM

If HSA's and "consumer driven" health plans are supposed to keep health care costs down, then why are premiums continuing to increase at a rate greater than inflation? How exactly are HSA's supposed to make health care more affordable, and how many previously uninsured people will receive quality healthcare due to HSA's?

Posted by: Uninsured | October 11, 2006 12:00 PM

I've been using my company's high deductable/HSA plan for several years now. I've saved lots of money because I'm healthy. If I had health problems I would not choose this plan over a traditional insurance plan (assuming I could get one while having pre-existing conditions).

And, I don't believe it's really "consumer driven". A few years ago I was deciding whether to have some optional blood work done to get some baseline information. I spent three hours on the phone with my doctor, the insurance company, the hospital, the lab, and maybe others, trying to determine what it would cost me, to no avail. All I could get was an upper bound estimate on the order of $400 - $500, but it could have been less due to whatever the insurance company had negotiated. Thus, I did not do the blood work. As others have said, the premise that consumers have access to all relevant information is just not true.

Posted by: AEW | October 11, 2006 5:08 PM

Annys:

Your experience seems pretty similar to what a lot of our customers are telling us here at Vimo: give us quality data! (Vimo is building a comparison-shopping site for health care products and services). It's a tough nut to crack: data is a fragmented, inconsistent, and in some cases totally unavailable. Couple that with the fact that providers are less-than-motivated to share this data and you get the kind of healthcare "gridlock" that we're now facing. Comparison shoppers need information to comparison shop.

The national budget is the forcing function here: something has to be done, and consumer-driven models are starting to produce some pretty impressive data that they do, in fact, work: people shop around, competition inhibits price hikes on the provider side, and the insurance companies pass this on in the form of drastically lower premiums. And studies are also showing that people in these plans *like* these plans. The last (crucial) piece of the puzzle is usable comparison data.

(Cue silly cavalry trumpet): Vimo, and companies like us, are working hard to "come to the rescue". Right now, patient reviews are probably the most useful data on doctors you're going to find, and yes, we've got lots of those. But look for some pretty cool quality-of-care information releases from us in the next quarter or two. I know a bunch of our competitors and partners have similar plans.

Maybe our company will come out on top, maybe one of our competitors will. But dimes to dollars says that the solution will come not from the Carriers - and certainly not from the Providers - but from Silicon Valley.

Posted by: Kurt Stammberger at Vimo | October 12, 2006 1:21 PM

What I've been experiencing in New York City is that more and more doctors are not accepting health insurance at all. It doesn't do you any good to have health insurance if the doctor won't accept it. Also, the "HSA" where I work has a no roll-over clause. If you don't spend the money within the year, you lose it. And there's a maintenance fee as well.

Posted by: Alison | October 16, 2006 10:20 AM

Consumer Generated Plans are a joke-all they do is move to costs over to the employee and says the post 10-25%.

Posted by: Andrew | November 1, 2006 11:04 PM

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