All posts by Martha Burton Santibanez

Health beat: Minnesota nonprofit helps rate doctors and plans

Article by: JEREMY OLSON, Star Tribune
Updated: November 21, 2014 – 5:15 PM

As thousands of Minnesotans wade through open enrollment season for workplace medical benefits, MN Community Measurement is encouraging them to evaluate their doctors along with their insurance options.

The nonprofit organization has emerged over the past decade as a leading source of information, uniquely Minnesotan, rating doctors on whether they provide optimal care to patients with diabetes, depression and other conditions.

There’s little doubt its public rankings have motivated doctors — aggregate measures of optimal care in areas such as diabetes have improved in recent years. But it has been unclear whether the data at www.mnhealthscores.org has influenced patients as they choose doctors and clinics.

Visits to the website have increased, but remain at a modest 100,000 per year.

But now leaders of the measurement organization believe changes in the nation’s health care system will make the rankings more attractive and more useful — both for Minnesotans reviewing employer benefits and for those buying health coverage on the open market or through the state’s health insurance exchange.

Many insurers are dropping plans that allow patients to see any doctors they choose, and offering cheaper plans with limited networks of doctors and clinics, said Jim Chase, executive director of MN Community Measurement. “It’s very important to look at the groups you are going to have access to or might choose for your care.”

Take, for example, the website’s new rankings for doctors’ management of asthma patients.

The good news is overall progress: The share of asthmatic children receiving ideal medical care in Minnesota clinics jumped from 49 percent to 56 percent. (This means they received recommended treatments and needed no more than two trips to hospital ERs for asthma flare-ups.)

The bad news is a huge gap among clinics. At Advancements in Allergy and Asthma Care in Minnetonka, 93 percent of pediatric patients received optimal care during the 12 months ending in June 2014; at seven other Minnesota clinics, zero patients received optimal care.

Chase said patients should ask about poor rankings, but look at multiple measures to get a broader picture of the quality of care provided by their doctors. Many patients now have tiered benefits that leave them paying more to go to certain clinics.

Chase said the rankings can help consumers make informed choices. “Is there much difference in quality, given the difference you might be asked to pay in price?”

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For consumers, health care cost and quality information remains hard to find and understand

Article by: JIM SPENCER, Star Tribune
Updated: November 22, 2014 – 2:00 PM

Getting basic information on costs and procedures remains a challenge in the Twin Cities.

WASHINGTON – The calls went out to a dozen randomly chosen health care facilities in the Twin Cities area. Staff members of the U.S. Government Accountability Office posed as patients who asked for the cost of common hernia repairs or colonoscopies.

Half of them could not get answers.

Those who received responses got price quotes that in some cases were three times higher than the competition with no quality measures to justify the higher charge.

“We were trying to put on the face of a consumer,” said Linda Kohn, who directs the GAO’s health care team. “The takeaway is that it is pretty hard to get this information.”

The government watchdog agency tested the availability of health care cost and quality data in several areas across the country. It picked Minnesota and Oregon specifically because both states have programs in place that are supposed to make it simple for patients to find good, affordable service as they choose between caregivers.

Minnesota also has a law that “requires providers to make estimated costs of treatment and estimated costs that must be paid by the patient available upon request,” GAO pointed out in a report released last week.

The report said that “initiatives to promote transparency” in Minnesota and Oregon did not guarantee cost and quality information. Of the 24 providers GAO contacted in both states, only 13 provided “limited” cost information and just seven provided quality data for hernia repairs and diagnostic colonoscopies for an uninsured patient. Of the 13 giving cost information, just five “were able to estimate … all of the facility, physician, anesthesia and other costs involved,” the report said.

“Our experiences receiving limited cost and quality information in two locations that have adopted specific initiatives to promote cost and quality transparency … suggest that consumers in other locations would face similar difficulties when calling providers,” the GAO concluded.

Kohn declined to name the Minnesota ambulatory surgery centers and outpatient facilities that were surveyed.

Four U.S. senators, including Minnesota Democrat Amy Klobuchar, requested the GAO study. It recommends specific changes to the federal Centers for Medicare & Medicaid Services (CMS) website to which most states, including Minnesota, often direct consumers for comparative health care data.

“Empowering consumers with accurate information about their health care options is a win-win,” Klobuchar said in an e-mail to the Star Tribune. “It helps cut costs for patients while improving our health care system across the board. That’s why I requested this report, and its findings make clear there is more work to do.”

As the GAO struggled to get accessible, understandable information at the state level, the agency identified what it called “critical weaknesses” in the CMS website. The federal site should include ways for individuals to estimate out-of-pocket costs for common medical procedures, the report said, and CMS should also organize cost and quality data in a way that lists top performing providers first.

Minnesota organizations in charge of informing health care consumers defended their programs, which are some of the nation’s most extensive. They challenged the GAO decision to call providers directly to ask for cost and quality information about specific procedures.

“It’s not representative of how most people are shopping,” said Wendy Burt, communications director for the Minnesota Hospital Association.

In 2007, the state Legislature passed a law requiring hospital pricing to be made public. As part of the law, the hospital association gathers cost information and displays it on a website called Minnesota Hospital Price Check. But the site only provides a general comparison of facilities, Burt said. For specifics, individuals must still contact their health insurance companies for costs that have been negotiated for their specific policies.

MN Community Measurement, a nonprofit set up in 2004 to improve health care in the state by making health information public, just “revamped” its website, mnhealthscores.org, “to make it more consumer-friendly,” said Tina Frontera, MN Community Measurement’s chief operating officer.

New cost-comparison data is being finalized for publication on the website beginning in January, Frontera said. She declined to elaborate.

The site now ranks care providers by performance for 14 common treatment areas. Ratings range from “Top” to “Below Average” based on “best practices, community consensus and national standards,” Frontera said.

“The GAO report highlights why an organization like ours is important,” she added.

The clinics the GAO called probably could not answer questions about cost and quality of specific procedures because, according to Frontera, “front line staff aren’t armed with training to provide that information.”

At the same time, Minnesota law requires health care providers and hospitals — or their “designees” — to provide “good faith” estimates of the costs of procedures to patients who request them. The costs are supposed to include out-of-pocket charges to patients, as well as charges to health insurers.

While the law is on the books, no one appears responsible for enforcing it. The Minnesota attorney general’s office said it was the responsibility of the state Health Department. But Diane Rydrych, the Health Department’s policy director, said the agency has no “explicit” enforcement authority outside of the ability to tell hospitals that they must disclose general pricing figures to the Minnesota Hospital Association if they refuse to do so.

As far as guaranteeing the law’s promise that consumers can get medical cost and quality information from health care providers on request, as the GAO tried, Rydrych said, “the assumption was it would happen.”

If it isn’t happening, she continued, “the legislature would have to consider whether they want to look at a different approach that has more of a regulatory flavor.”

Jim Spencer • 202-383-6123

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Join MNCM as a Sponsoring Member Today!

With just seven weeks left in 2014, many organizations are finalizing their end-of-year contributions and establishing their 2015 budgets. We hope you’ll add MNCM to that list. As a sponsoring member, you’ll help support the improvement of health through measurement and public reporting.

Since 2002, MNCM has contributed toward significant improvements in the quality of care for diabetes, heart disease, depression, asthma, cancer screenings and more – but there is still much more to do!

In 2015, we will publicly report pediatric preventive care, total knee replacement and spinal surgery outcomes for the first time, as well as our second report of statewide clinical patient experience. We will advance measure development activities focused on cancer care, colonoscopy quality and low back pain, as well as cost and value of care.

We remain committed to creating high-quality, broadly-applicable measures that lend themselves to alignment of state and national initiatives to improve the quality and experience of care, while making it more affordable.

With the help of sponsoring members like you, we will continue to bring individuals and organizations together to improve the health of our community.

Join us today!

If you’re interested in becoming a sponsoring member or would like more information, please contact Jaime Johnson at johnson@mncm.org or 612-746-4517.

Don’t forget! Since MNCM is a 501(c)(3) non-profit, your organization’s contribution may be tax deductible.

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Quality Field Notes: How to Build a Sustainable Patient Experience Program

What is the best way for providers to get objective and actionable information on whether they are delivering patient-centered care? Ask the patients.

Patient experience surveys, particularly those that use validated questions such as the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Surveys (CG-CAHPS®), give providers feedback on patients’ office visits. Practices can then take specific steps to improve the care experience.

A new suite of materials from the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) initiative includes an issue brief, and related resources, exploring key lessons on how patient experience surveys help providers better understand and deliver patient-centered care and help consumers find the best care for themselves and their families.

View the full suite of Quality Field Notes materials on patient experience >>

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Minnesota Cancer Alliance Summit 2014

Minnesota Cancer Alliance Summit 2014

Minnesota Cancer Alliance Summit 2014

Cancer Care – Its a Partnership

Thursday, Nov. 6, 2014 from 8am-5pm at Hilton Minneapolis/Bloomington, 3900 American Blvd W, Bloomington, MN 55437. The 2014 Summit will feature a full day meeting, with a mid-day awards luncheon and closing evening reception.

Please join us

Registration is now open. This year’s Summit promises to get people thinking about patient centered care across the cancer continuum, from primary care to oncology care to hospice care. Dr. Julie Silver, Associate Professor at Harvard Medical School and co-founder of the STAR Program® (Survivorship Training and Rehab) will set the tone for the day as keynote speaker. The Summit also will feature a plenary session led by representatives from across the cancer community. Evidence-based programs and best practices in cancer prevention, early detection, treatment and survivorship will be highlighted in breakout sessions that focus on topics ranging from patient navigation and shared decision-making to clinical trials and palliative careSummit organizers aim to promote ongoing regional partnerships and to create networking opportunities for people interested and passionate about cancer control.

Call for presentations

The Alliance invites medical and public health professionals, community-based organizations, community engaged researchers, and students to submit abstracts for breakout session presentations that address the Summit theme of patient centered care across the cancer continuum. Applications to present at the Summit will be accepted until midnight, September 5, 2014.To submit an application, visit http://www.intrinxec.com/cancersummit/presentation/.

Space is limited

Early bird registration ends September 30th. Scholarships will be available on a first come first served basis and can be requested at registration. To register for the Cancer Summit 2014 please visit http://www.intrinxec.com/cancersummit/registration/ For more information contact: Heather Hirsch at 651-201-3620. The Minnesota Cancer Alliance (MCA) is a coalition of over 100 organizations from diverse backgrounds and disciplines dedicated to reducing the burden of cancer across the continuum from prevention and detection to treatment, survivorship, and end of life care. For more information, visit www.canceralliance.org.

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Becoming a Sponsoring Member today!

As a neutral, community-wide convener, MN Community Measurement has been a national pioneer in collaborative and transparent health care quality performance measurement. For us to continue to be effective, we need broad support from the community for our critical work on quality, cost and patient experience measurement and reporting.

Our proven track record includes:

⇒ Compare clinics for quality of treatment

⇒ Compare the average costs of procedures like colonoscopy, c-section delivery and vaccinations

⇒ Compare patient experiences at individual clinics, including communication, office staff and whether they gave the clinic a top rating

  • Successful alignment of state, federal, pay for performance and insurance provider contracting to use the same measures, thereby increasing efficiency for providers
  • Developing tools and resources to help consumers make informed health care choices
  • Continual development of new measures to support community and consumer needs, such as knee and spine surgery outcomes and pediatric mental health and obesity care

For an annual contribution, you’ll support this critical work and receive benefits such as:

  • Notification of applicable board and committee openings
  • Notification of measure development workgroup participation and other feedback opportunities
  • Opportunities to network with MNCM leaders and other members who are passionate about health and health care quality
  • Discounted rates to attend our annual one-day seminar
  • Recognition on MNCM.org
  • Access to member-only webinars and our monthly e-newsletter

With the help of sponsoring members like you, we will continue to bring individuals and organizations together to improve the health of our community.

For more information on becoming a sponsoring member, please contact MNCM’s Membership and Communications Project Manager, Jaime Johnson, at johnson@mncm.org or 612-746-4517.

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Doctor Performance Gets a Checkup

June 23, 2014
Robert Wood Johnson Foundation

Aligning Forces for Quality (AF4Q) collaborates with Consumer Reports to help consumers make informed health care choices

Are you receiving quality care? How would you know? With a grant from RWJF and in collaboration with AF4Q communities, Consumer Reports published information comparing the quality of doctors in three states.

Patients generally don’t practice medicine, so it can be hard for them to know just what constitutes high-quality care. In the absence of easy to understand, objective information, health care consumers might never know how well their physicians measure up.

Aligning Forces for Quality (AF4Q) alliances have been leaders in measuring and publicly reporting the performance of physician practices. The challenge has been ensuring that patients have access to and use this data to make better care decisions.

This case study highlights how three AF4Q communities—Greater Boston, Minnesota, and Wisconsin—partnered with Consumers Union to publish special inserts in its magazine, Consumer Reports, to provide consumers with access to performance data for local medical practices.

These reports help physicians and hospitals identify areas for improvement; guide consumers’ decisions in choosing high-quality providers; and offer employers and insurers objective information on the quality of care being delivered.

Massachusetts
Ratings on nearly 500 adult and child primary care practices based on patient experience.

Minnesota
Ratings on 552 medical practices based on their success at helping patients achieve key targets in managing cardiovascular disease and diabetes.

Wisconsin
Ratings on 19 medical groups (when combined, these serve nearly half of the state’s patients) based on their success at providing patients with any of seven medical services.

Read the full report here.

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2014 MN Rural Health Conference Features Health Care Disparities Report

Rural health conference set

By John Lundy, Duluth News Tribune
McClatchy-Tribune Information Services
June 19, 2014

The annual Minnesota Rural Health Conference will take place Monday and Tuesday at the Duluth Entertainment Convention Center.

More than 500 health care professionals, educators, state health workers, policymakers and students are expected to attend, according to a news release from the National Rural Health Resource Center. It sponsors the event, along with the Minnesota Department of Health’s Office of Rural Health and Primary Care and the Minnesota Rural Health Association.

The screening gap Minnesotans with public health insurance are much less likely to be screened for colorectal cancer than those on private plans.

That’s the conclusion of the seventh annual Health Care Disparities Report conducted by MN Community Measurement and sponsored by the Minnesota Department of Human Services.

In 2013, 51.8 percent of Minnesota Medicaid-covered adults ages 50 to 75 were screened for colon cancer, compared with 71.8 percent of those covered by other types of insurance, the American Cancer Society said in a news release.

That’s the largest disparity among the 13 measures tracked by the report.

Colon cancer is the third-leading cause of cancer-related deaths in the United States.

View the entire Duluth News Tribune article.

 

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Optimal Asthma Care Updates

As we’ve mentioned previously, changes were recently recommended to the Optimal Asthma Care measure. Since that action was taken, two additional decisions have been made regarding the implementation of that change.

  • MNCM will include the written asthma management plan component as an optional (voluntary) measure for the 2015 report year. Medical groups can use this information to support their quality improvement programs, but it will not be included in public reporting.
  • Also beginning with the 2015 report year, MNCM will publicly report both the composite score and the component scores for asthma control and risk of exacerbations. Historically, only the composite score has been publicly reported.

If you have any questions, please contact MNCM at info@mncm.org or 612-746-4522.

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You’re Not on the ‘Best Doctors’ List — Does It Matter?

By Shelley Reese
Medscape Business of Medicine, May 28, 2014

The List Is Out — and Your Name Isn’t There

Are you a “top” doctor? Do you care?

Every year, metro magazines around the country publish lists touting the “top” and “best” doctors in town. The issues are money-makers for the magazines and PR fodder for hospitals and health systems. But doctors themselves appear to be wildly ambivalent — and highly skeptical — about the lists.

Who Says Those Are the “Best” Doctors?

Nationwide there are a lot of variations on the top-doctor theme. There are “best” doctors and “most influential” doctors, and selection criteria vary.

While most doctors are quick to recognize and dismiss lists that are simply paid advertisements, their reaction to the peer-nominated “top” and “best” doctor lists frequently published in city and consumer magazines is more complex.

For example, many city and consumer magazines partner with New York-based Castle Connolly Medical Ltd. to compile their lists. Physicians are asked to nominate doctors who, in their judgment, are the best in their field. The firm’s research team then vets nominees to check board certifications, licensing, and disciplinary histories. Physicians cannot nominate themselves and do not pay to be on the list, but they may pay to advertise in the magazine publishing it or for plaques showcasing the recognition.

Physicians are generally happy to make such lists. “Physicians are proud of what they do,” says Kenneth T. Hertz, a principal with MGMA Health Care Consulting Group. “They’re proud of their education and skills.”

But what about the doctors who don’t make the list? A lot depends on the doctor, says Amanda Kanaan, President of WhiteCoat Designs, a Raleigh, North Carolina-based medical marketing firm. Some may have bruised egos. Others may express disdain for the list, while secretly wishing they’d made it. Still others simply don’t care.

Is It a Blow to Your Ego?

Whether the lists have value for physicians beyond bragging rights is open to debate. Hospitals and health systems are quick to issue press releases touting their “top” doctors. Some physicians practicing in competitive markets say making a list can be a huge career booster, attracting new patients and media attention. Others who already have busy practices say they don’t need to have their name on a list to attract patients.

“There are good arguments on both sides,” says Kanaan. “From a marketing perspective, a doctor’s reputation is all that he or she has. They can provide amazing care, but if they don’t have the reputation, patients aren’t going to walk through their door.”

When physicians ask her opinion about whether they should purchase an advertisement in the magazine or a plaque for the waiting room, Kanaan says it’s important to consider their individual circumstances. Do they need help with reputation management? Have patients been slamming them in online reviews? How credible is the list in question and how much do they intend to spend?

“These things can get expensive, and sometimes doctors don’t realize how expensive they are,” she says. “The biggest cost is usually advertising in the magazine, but in some cases, participating is buying into a PR opportunity that entitles you to use the ranking organization’s logo on print and marketing materials.”

Too often, she says, physicians participate not because they want to but because they feel obliged to do so. They participate because the competitor down the street is a “best” doctor or because their partner has a plaque hanging in the waiting room and they don’t want patients to perceive them as inferior. Likewise, if they buy a plaque one year, they feel compelled to do so the next, lest patients think they didn’t make the list a second or third or fourth time.

“For many doctors, it becomes one of their yearly marketing expenses,” Kanaan says. “They realize that if they don’t do it, then there could be repercussions.” In that regard, she says, the lists “somewhat have doctors on their knees: If they don’t participate, they’re going to send the wrong message.”

Specialists, particularly those in highly competitive fields or whose services aren’t covered by insurance, seem to feel the greatest pressure, she says. While patients often choose primary care physicians based on convenient locations, they are willing to travel much further to find a specialist, making it more important for specialists to differentiate themselves.

“I see the value of these as a marketing tool,” Kanaan says. “But this is just one very, very small part of what it takes to market a practice, and it’s not even a necessary part. If I had a limited marketing budget, this would not be my first priority. Not by a long shot.”

What About “Paid” Lists?

Wanda Filer, MD, who practices family medicine in York, Pennsylvania, and earns top marks from patients on Healthgrades and Vitals, says she frequently receives congratulatory letters in the mail that she’s made one list or another. She doesn’t bother to open them.

“I don’t put much credence in the lists. I get notifications fairly often, and to me it always looks like they’re trying to sell a plaque. I’d rather let my work speak for itself.”

Dr. Filer says she thinks other doctors feel the same way. As a board member for the American Academy of Family Physicians, she often introduces speakers at conferences. In preparation for that, “I look at a lot of CVs for physicians from around the country,” she says. “Rarely do I see ‘top doctor’ recognition listed among their accomplishments.”

While a lay audience might put stock in a list of doctors recognized by other doctors, Dr. Filer says physicians themselves know the choice of specialists should be patient specific.

“I just saw a patient who needs knee surgery and asked for a referral,” she says. “I considered two practices. They’re both excellent, but one is more interconnected with an EMR than the other, which is important because he’s an older patient with other health issues. The other group does a great job with knees, but they may not have access to his cardiology record and my records. Nowadays we know that coordination of care is more important than ever, and it’s helpful for me to think through the systems issues when selecting a doctor.”

Another reason Dr. Filer says she doesn’t concern herself with “top” doctor lists: She’s a busy primary care physician. “We’re always trying to find a place to put patients. We’re not out there actively recruiting. A specialist who has more head-to-head competition might feel differently.”

Just a Popularity Contest?

Betsy Tuttle-Newhall, MD, Division Chief of Transplant Surgery at St. Louis University, who likewise earns top marks from patients on Healthgrades, has a different take on the lists. She hasn’t been nominated for one, she says. A relative newcomer to St. Louis, she regards the local top doctors list as “a popularity contest” rather than affirmation of clinical skills.

“CMS tracks my performance. They know my mortalities and my length of stays,” she says. “I know I’m above standard of care, but I never make this list in town.”

Jim Chase, President of Minnesota Community Measurement (MNCM), a nonprofit organization that collects performance data on physicians in the state, says the lists may be revenue generators for the magazines and PR opportunities for the showcased doctors, “but they’re not very important to the quality side or to directing people to the right care providers.”

He says that about eight years ago, MNCM approached Minnesota Monthly about incorporating their patient satisfaction data into its “best doctors” issue.

“They weren’t interested,” Chase says. “They didn’t want to alienate the doctors. They were worried that if the physicians didn’t like the kind of data we were publishing — because we publish both the good and the bad — they  wouldn’t advertise with them.”

But What Does the Patient Think?

While doctors may have mixed feelings about the lists, consumer reaction is even harder to gauge.

It’s unclear how much stock the public puts in the lists, which emphasize doctors’ opinions. It would be hard to make a case that they have no value to the public. However, there is solid evidence that patients value the insights of their fellow patients when selecting a doctor and that they do consult doctor-rating Websites.

In a survey of more than 2100 Internet users, 59% say Internet ratings on sites such as Yelp, Healthgrades, and RateMDs are at least “somewhat important” in choosing a doctor, according to a report published in the February 19 issue of JAMA. Of those, 19% say Internet reviews are “very important.”

Patient review sites may be imperfect, but Chase notes that they discuss not only the doctor but also the staff, wait times, follow-up, and other issues that are critical to the patient experience.

“Patient behavior has changed,” Kanaan says. “There are a gazillion doctors out there and patients are confused. They go online just as they would go searching for something to buy. I don’t see these ‘best’ lists competing in the online space.”

To read the article, go here.

 

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Location influences cost of visit to a doctor

By Donovan Slack, USA TODAY/ Gannett Washington Bureau
Updated 9:39 a.m. CDT May 5, 2014

When it comes to the price of visiting a doctor, location matters in Minnesota.

If you visit a family care physician for the first time up north in Warren, for example, the bill could run as low as $150. The average charge for the same initial visit at a suburban Minneapolis clinic? Possibly as high as $313.

Billing amounts also vary within cities and regions of the state, according to data released by the U.S. Department of Health and Human Services for the first time in 35 years. It shows what health care providers billed Medicare for services.

Although they are only for Medicare patients and just a portion of what is billed is actually paid, the billing records provide a glimpse of what top-line prices typically might be for all patients. And like sticker prices on cars, they offer a way to compare general rates.

That information is more critical than ever. With the growth of high-deductible health insurance plans, patients are paying more out of pocket, forcing them to shop around for the best deal.

A Gannett Washington Bureau analysis of the data for Minnesota found that there is indeed reason to comparison shop.

In Central Minnesota, the charge for an initial office visit by a Medicare patient to a family practitioner in 2012 ranged from an average of $125 each for a solo practitioner in Cold Spring to $263 for a pair of doctors at a HealthPartners clinic in St. Cloud.

The statewide average for such a visit was $200. Family practitioners at the Mayo Clinic — which accounted for 23,500 of the 150,000 Medicare average provider billing records released for Minnesota — charged $120 to $150.

Charges also varied among specialists around the state.

Cardiologists and thoracic surgeons submitted bills ranging from $1,200 to $3,900 to insert pacemakers and $5,800 to $10,900 to repair faulty heart valves. The single highest average physician charge was for total knee replacement surgery at a Mayo Clinic in Albert Lea, where bills for 21 such procedures averaged $11,900 each.

A starting point

The American Medical Association, which fought the release of the data for decades, argues the records do not provide enough details for people to make accurate determinations about health care providers.

“This information isn’t going to necessarily allow them to determine ‘Is my doctor good? Is my doctor not so good?’ ” AMA President Dr. Ardis Dee Hoven said. “There’s no way for them to know how this relates to quality, how it relates to health outcomes and access and all sorts of issues. Raw data simply does not give the correct determination of value.”

Hoven also noted that the accuracy of the data has not been verified with the doctors themselves. In a few cases, Gannett found mistakes in the records. For example, one doctor listed in Minnesota was actually working in another state. The data also does not include facility fees that hospital-based providers can tack on. That may make their billed rates appear artificially low.

But some industry groups say the records at least provide an important jumping-off point for asking more questions, such as why are charges high or low, and what’s included in the price?

“The unfortunate thing is consumers don’t even know where to start in asking the question,” said Carolyn Pare, president and CEO of the Minnesota Health Action Group, a coalition of companies and others that buy insurance and want to reduce costs. “And now having this out in the public, to a certain degree, gets consumers asking the question.”

Many factors affect the rates that providers set, from basic overhead expenses such as rent to the mix of patients a practice has, Minnesota health care providers say.

More Medicare or Medicaid patients might prompt a higher billing rate for other patients because federal insurance for poor and elderly people only covers a fraction of what providers say it costs to treat them. The average amount Medicare actually paid for the initial office visits in Minnesota was $65, according to the 2012 data.

At CentraCare Health, Chief Financial Officer Tom Feldhege said prices are determined in part by the resources needed to provide care at a given facility.

“These resources translate into costs, including professional fees (provider’s time, expertise and training, malpractice insurance), patient care staff (nurses, other clinical staff, imaging, front desk, schedulers, etc.), staff behind the scenes (IT, billing, medical records, cleaning, quality, administration), equipment, furniture, facility costs and overhead (water, lights, electric, etc.),” he wrote in an email.

Keeping costs down

Some providers say they have deliberately tried to keep costs low by eliminating unnecessary tests, medications and other ancillary costs and focusing on managing care efficiently. At Mayo, spokesman Bryan L. Anderson said he’s not surprised the Medicare billing records reflect comparatively low rates for Mayo providers.

“This data reflects the ‘Mayo Model Of Community Care,’ with an emphasis on a physician-led team to care for patients,” Anderson said.

Dr. Christopher Wenner, the solo practitioner who charged the lowest amount in Central Minnesota — $125 on average for a moderately complex first-time visit — said he keeps his overhead as low as possible. For example, he has only one assistant at his Cold Spring office.

“It’s nice to have a lot of administrators and a lot of people to do things,” said Wenner, who worked at a multispecialty provider before opening his solo practice. “But medicine is so inflated with different levels of administrators and bureaucrats, and I’m very convinced that it contributes to the overall cost of medicine.”

The provider with the highest average charge statewide for an office visit by a new patient, Allina Health’s Sports and Orthopaedic Specialists in Edina, said the family practitioner who billed $313 each for initial visits, on average, has additional certification in sports medicine.

“The visits in question are sports injury or other types of orthopedic visits,” Allina spokesman David Kanihan said. “It is therefore not appropriate to compare her to regular family practice doctors.”

That doctor’s average billed rate, however, was also higher than the average billed for sports medicine specialists in the state ($180), orthopedic surgeons ($215) and neurosurgeons ($220).

In the central part of the state, a spokesman for HealthPartners Central Minnesota Clinics said he could not explain the average $263 billed by two doctors at a clinic in St. Cloud.

“Without knowing more about an actual patient visit, we can’t speculate further as to the type of care provided by our physician and the associated expense for that care,” spokesman Adam R. Bauer said.

He also said that first-time office visits can include various levels of service in a wide array of settings, including retail clinics, urgent care clinics and home visits.

Pare of the Minnesota Health Action Group said the conversation about cost previously has been almost exclusively between insurers and providers. Getting more consumers involved now — because they have “skin in the game” with high-deductible plans — is an important step forward.

“We’re trying to move from a totally opaque system to something that is a little brighter,” she said. “And I think this information should be used to ask questions, not necessarily to say everything’s bad, but to start asking questions and having an honest dialogue about how we’re going to change.”

At MN Community Measurement, a nonprofit dedicated to improving quality and value in health care, President Jim Chase said his organization has long known there are variations in pricing. MNCM posted data on clinics and hospitals in the state on mnhealthscores.org.

“You still need to look at your own plan’s data to be able to see what you might pay or what your variation might be,” he said. “But we were doing it mainly to raise awareness that cost matters, and the pricing in costs matters, because there’s a lot of differences.”

Read the full article: http://www.sctimes.com/story/news/local/2014/05/05/location-influences-cost-visit-doctor/8711029/

 

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