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JournalistBlood test: $522 or $19? We’re New Orleans journalists digging into the murky waters of health care pricing. Ask Us Anything!

Aug 24th 2017 by NOLAnews • 11 Questions • 384 Points

We’re Jed Lipinski, a reporter for NOLA.com | The Times-Picayune, and Lee Zurik, a reporter for WVUE Fox 8 News.

For the past few months, we’ve been writing about the cost of health care in Greater New Orleans as part of our “Cracking the Code” series. With help from ClearHealthCosts, a New York-based journalism start-up, we’ve exposed how the cost of common medical procedures varies dramatically depending on your provider or health insurance.

Routine blood tests, for example, can be had at Touro Infirmary for $522, or for just $19 half-a-block away at Clinical Pathology Laboratories. At one local radiology facility, United Healthcare pays $1,005 for an MRI of the spine, whereas Blue Cross and Blue Shield of Louisiana pays just $464 – a difference of $541.

Through our reporting, we learned that the cost of most medical procedures is intentionally hidden from the public. As a result, most patients have no idea what they will pay prior to visiting the emergency room or undergoing an operation. This directly benefits insurance companies and health care providers, whose prices often have no relationship to the cost of the service itself. Overcharging is the norm.

Our goal throughout has been to enable consumers to make educated cost decisions about their health, the same way they can about food at the grocery store or fuel at the gas station.

Thanks for having us. Ask us anything!

PROOF: https://twitter.com/NOLAnews/status/899965659861442560

Edit: Stories call, so we're stepping away from the keyboards. We'll be back to answer your questions throughout the day though, so keep posting them if you have them.

Q:

Are prices are fudged depending on the number of unprofitable services that the hospital provides? For instance if a hospital needs to pay for a lot of elderly folks or medicaid folks or people that simply don't pay their bills, the hospital would want to charge more for other procedures. Is this a large factor in the price discrepancy?

A:

Jed: Great question. It's something we addressed in a May story about facility fees, where a clinic affiliated with a hospital charges an extra fee for the "facility" -- as if medical procedures would take place anywhere other than a facility. (Outside?) In this story, a woman was hit with a $137 facility fee because the sports medicine clinic she went to was affiliated with Tulane Medical Center across town. Tulane Medical Center has a busy 24-hour ER that takes in a lot of people who can't afford to pay. So they (and other hospitals in similar situations) will try to justify charging extra fees, like a "facility fee," because they lose money by providing services that small clinics without pricey ERs don't have to bother with.

As we wrote in the story: "Federal law allows hospitals to charge facility fees for outpatient services at affiliated clinics, regardless of whether the clinic is anywhere near the hospital. The clinics may have the same equipment, staffing and operating expenses as a private practice, and may look much the same as a private practice, but the simple fact that they're connected to a hospital entitles them to charge that extra fee."

http://www.nola.com/health/index.ssf/2017/05/facility_fees_new_orleans.html


Q:

Thanks for your response! So how much would you attribute varying fees to simply shuffling money around to cover bills? Because if its 100%, then you essentially have a zero-sum game and there is no solution that doesn't involve pinching the ERs. Although you could expect some efficiency improvements to result from patients shopping around, people will never shop around for ERs. So how much would the practice of shopping around for basic healthcare hurt the finances of ERs?

A:

Jed: Another good question. Big hospitals like Tulane are certainly doing a form of public service by treating patients that they know are unable to pay. How else would they get treatment? But does that mean that patients who go in for a shoulder exam at an affiliated clinic should be picking up the bill for the ER? It's ultimately the responsibility of the state and federal government to ensure that hospitals like Tulane have enough money to keep their ERs open. The absurdity of the current situation is evident in the fact that facility fees are often higher than the actual doctor's fee.


Q:

Why does it work better in other counries like Germany but not in the US? TL

A:

From Jeanne Pinder:

Germany has a combination of mandatory, essentially public, insurance, which covers most people, and also optional private insurance for people who can afford it.

They also have one other big difference in their health care system: fewer for-profit entities.

I am all for free enterprise, but in health care it doesn't work that well: a for-profit insurance company or hospital is answering to its stockholders, and that necessitates tradeoffs. For-profit Big Pharma is looking for, well, profits. See Epi-Pen.

Here's a nice Atlantic piece on the German system from a few years back. https://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/


Q:

Any initial ideas on why healthcare is so expense?

A:

Any initial ideas on why healthcare is so expense?

I think it all starts with price transparency. When you go buy a TV or a car, you know the price going in. You can compare prices from different stores. In healthcare, the prices are typically hidden. You don't know the cost going in. It allows providers to charge what they want, instead of what the market wants. - Lee Zurik


Q:

I agree with that, but dont you think another issue that causes the broken price structure is the bureaucracy and red tape? Unnecessary paper-pushing tacks on alot of extra cost, and as a result some of those costs can't be as transparent.

A:

We a few doctors tell us the high costs are often attributed to high administrative costs at hospitals. I have seen a few articles on that subject too. - Lee Zurik


Q:

when looking for sources and tipsters within health care for a story, where is generally the best place to look? doctors? recently-fired insurance company employees?

A:

Jed: Good one. Having just gone through a months-long project about health care pricing, I can say an excellent way to find tipsters and sources is to do what we did: Publish a few stories about the drastic disparities in health care costs in your region. It's an enormous problem that most people are reluctant/embarrassed/ashamed to talk about, but once you start airing it in public, people rush to tell their story. For weeks, we received dozens of emails and voice messages per day from a wide variety of people -- including MDs and former health insurance employees -- who often spoke to us on the condition of anonymity but pointed us in the right direction. It took gathering some eye catching data -- A $522 blood test could be had for $19 across the street? -- to get the ball rolling.

This was the story that kicked it off for us: http://www.nola.com/health/index.ssf/2017/04/new_orleans_health_prices.html. Allowing the community the opportunity to post their medical costs and bills and stories anonymously was also very helpful in gathering sources and tips


Q:

what was the most unexpected tipster or source you encountered (like say a health care CEO)?

A:

Jed: We heard from the owner of local radiology clinic who provided us with the rates that different insurance companies pay for the same procedure. This was mostly likely a violation of his contract with the insurance company, but we gave it to us anyway. http://www.nola.com/crime/index.ssf/2017/07/health_insurance_new_orleans.html


Q:

Why is dental care so damned expensive?

A:

Jeanne Pinder of ClearHealthCosts points out that on their home site, they also have data for San Francisco, Los Angeles, Philadelphia, New York , Miami and Tampa-St. Petersburg. Just go to their site and search. You can also share your prices (click on button at top right of home page).

If you are not in one of those areas, you can still use the advice on how to find out what stuff costs in advance in this blog post: https://clearhealthcosts.com/blog/2017/04/find-stuff-costs-10-easy-questions/

And also note some general principles; In San Francisco, for example, a simple MRI can cost $450 or $6,221. In New York, the range is $350-$2,783. So broad variations in prices are the rule, not the exception--not just for this procedure, but for pretty much all procedures.

Ask! Always ask!


Q:

Speaking to your point about consumers asking questions: my GP sent me to a dermatologist to have a small cyst removed. I spoke with the office beforehand and said that I do not wish to have it tested, it is just a fatty cyst and they said ok. When I got the bill it was $1,000 and a big part of that was the testing I asked them to leave out. When I went to question this they said that is standard policy and made me go on a payment plan to pay the bill. In an instance like this, does the consumer have any path of recourse? I felt like I didn't.

A:

From Jeanne Pinder:

We tell people to get price quotes in writing in advance. That makes it easier to appeal. Here's our story about 10 questions to ask in advance.

http://www.nola.com/health/index.ssf/2017/05/10_questions_to_find_out_what.html


Q:

Where did you get the big balls to go against a conglomerate like this? And also, may I thank you for your big balls (or ovaries if applicable)?

A:

Jed: Well thanks. And good question. I think they came partly from our partnership with ClearHealthCosts, whose team did the tedious and frustrating but crusading work of reaching out to every major health provider and clinic in the greater NOLA area and asking for the cash prices of their most common procedures. They then helped us create an online database to store the data they received, so we could begin writing stories off that data, which elicited more data from consumers, etc. It's a magical formula for journalism, and a great way to take the powers that be by surprise.


Q:

When I have trouble with my taxes, I can pay an accountant. Trouble with the law, I can pay a lawyer. Can I pay somebody to help me get the best deal when spending money on healthcare?

A:

From Jeanne Pinder:

  1. you could look at our work: learn about how to protect yourself. this is a DIY option. educate yourself about how to find out what stuff costs in advance https://clearhealthcosts.com/blog/2016/10/much-will-costdid-cost-part-1-series/ and how to appeal a denial or similar https://clearhealthcosts.com/blog/2016/12/appealing-claim-denial-draft-spm-notes/ Learn how people use our data: https://clearhealthcosts.com/?s=how+people+use+our+data
  2. you could try to use your provider and insurer tools. we want to hear how this works for you!
  3. go to the ClearHealthCosts blog and search the procedure you're looking for to understand the range of prices https://clearhealthcosts.com/blog/
  4. there are people called "medical billing advocates" and similar --they work on contingency or flat-fee, and promise to save you money. we don't know much about them and because of this, we do not recommend any. if you find a good one or ones, please let us know! and thanks!