Most states fail when it comes to providing publicly available information on the quality of their physicians, according to a new report.
The Health Care Incentives Improvement Institute gave 40 states and the District of Columbia a failing grade of “F” while four other states received a “D,” which is also considered failing. Thus, a majority of Americans – more than four in five – are making uninformed choices when it comes to choosing a physician, authors of the report say.
States were graded on the availability of quality information on physicians as well as how accessible it was to the public. The findings are disappointing given the push by employers, insurance companies and health policymakers for more transparency in health care at a time millions more Americans have medical care coverage under the Affordable Care Act.
“Consumers are flying blind when it comes to selecting hospitals and physicians, and the overall quality and affordability of American health care won’t be improved until we find a way to solve this problem,” Francois de Brantes, executive director of the Institute, known as “HCI3” in the industry, said in a statement accompanying the report.
Just six states passed with a “C” or higher. Minnesota and Washington each earned an “A” while California and Maine received “B” grades. Wisconsin and Massachusetts were each awarded a “C.”
In a state like Minnesota, which earned a rare “A” for its quality reporting, doctor practices are compared on several performance measures as well as the patient’s experience in the doctor’s office. Measures and comparisons of practices are available on conditions like asthma care and colon cancer screenings on the Minnesota HealthScores web site.
Though insurance companies like UnitedHealth Group UNH -0.21% (UNH), Cigna CI +0.12% (CI), Aetna AET -0.1% (AET) and Humana (HUM) have their own ratings for doctors, health plan information isn’t part of the Institute’s report. Consumers often don’t trust insurer ratings, industry analysts say, so advocates for transparency are pushing states to disclose more doctor quality information to the public. The information from those states earning high grades generally comes directly from the doctor practice or hospital system.
“The goal of this report is to not only highlight efforts that are doing well, but also to grab the attention of lawmakers in states lacking this vital information for their residents,” de Brantes said. “If your state isn’t receiving an A or B, it can and should.”
Providing high quality care at the lowest cost is a tough double play for doctors to turn.
Yet a small Twin Cities practice is getting national notice for the feat, even while going up against competitors with, well, bigger payrolls.
A Stanford Medicine think tank recently examined 15,000 primary care groups across the country, stripping away clinics that didn’t finish in the top 25 percent for quality, and also in the top 25 percent for low cost.
About 750 were left. Researchers with the Peterson Center on Healthcare then looked for the best of the best and came up with 11 “most valuable” groups.
One was Northwest Family Physicians, a primary care group in Crystal, Plymouth and Rogers.
Defying stereotypes that only large groups can provide affordable care in modern medicine, the 16-doctor practice made the cut for a variety of innovations, including “up-skilling” their doctors so they can provide procedures such as colonoscopies and allergy tests in-house.
“The cost is significantly lower than doing these things in a hospital,” said Dr. James Welters, Northwest’s president and chief medical officer.
Good fortune allowed the practice to stay independent. Others have found new requirements such as electronic medical records so expensive that they have had little choice but to merge or get bought out.
Northwest invested in e-records a decade ago, when the cost was more manageable. Now, e-records are integral to the clinic strategy of keeping patients caught up with care.
“A cold is never just a cold in our office,” Welters said.
Not that Northwest is perfect. MN Community Measurement ranks Northwest highly for diabetes and depression care, but ho-hum for asthma management and cancer screenings. Welters said that is one limit of being small: the practice can’t improve in all areas at once. But the recognition is still worth celebrating while his group keeps working at improvement.
“It’s not just for us,” he said. “It’s for people like us — smaller, independent primary care clinics. Unfortunately, the health care system is stacked against us.”
The stakes are high for the world-class hospital, which must transform itself amid a new era of reform.
Story by Jeremy Olson
Angie Carlson faced a tough choice when buying health insurance for her employees at DataIQ in Eden Prairie last year: Keep her existing coverage, which allowed employees to use the vaunted Mayo Clinic, or exclude Mayo and instantly save 5 percent on premiums.She knew her workers would appreciate the savings. But how would they feel about losing access to one of the best known health systems in the world? None of them had ever traveled to Rochester for medical care, but one had an eye condition that might suddenly require sophisticated treatment.“What if that worsens?” she wondered.Carlson stuck with Mayo this year, and will do so again next year. But her debate underscores the challenges facing Minnesota’s premier medical institution as economic, demographic and political forces combine to transform the way health care is delivered and paid for in the United States.Mayo has been lauded by President Obama and influential health economists as an example of superb care and medical efficiency. Yet Mayo also has a reputation in Minnesota — confirmed by publicly available health data — for high prices.
How Mayo resolves that paradox will determine the future of a clinic that has become a signature Minnesota brand. Mayo draws patients from all 50 states and more than 130 countries each year. With nearly 41,000 Minnesota employees, it is the state’s largest private employer and, as of this year, a partner with taxpayers in a $327 million venture to elevate the state as a global medical destination.
“If Mayo Clinic were perceived as being too expensive and not worth it, it would be a huge risk to the organization,” said Mayo CEO Dr. John Noseworthy.
As Mayo celebrates 150 years of history, it’s adapting aggressively to meet the coming wave of reforms. It is extending its brand nationally through exclusive affiliation agreements with smaller hospitals around the country. It’s investing more money in a lab that develops and exports cost-saving medical techniques. And it’s formed an unusual alliance with the nation’s biggest health insurer, UnitedHealth Group, to use “Big Data” to prove and improve the value of Mayo’s services.
Premium care, prices
The financial squeeze facing hospitals and clinics has been building for years; total U.S. health spending has slowed sharply since 2008 and last year grew at the slowest pace on record.
But the scale of Mayo’s challenge became clear last year with the debut of Minnesota’s MNsure insurance exchange, which allows consumers to compare health plans by price and coverage. The only plan in Rochester to include Mayo Clinic as an “in-network” provider cost two to three times more than comparable insurance plans in the Twin Cities. Eventually, state regulators persuaded a second insurer, Medica, to offer a plan on the exchange for Rochester-area residents. But even its network did not include Mayo’s primary care clinics in the city of Rochester itself.
Mayo’s leaders argue that the cost figures are misleading. They say data comparing Minnesota hospitals fail to reflect the fact that Mayo treats sicker patients and more complicated diseases — some of which have been mistreated or misdiagnosed elsewhere.
But a Star Tribune analysis of 2012 hospital and insurance data found that Mayo charges more than its Minnesota competitors for even the most common procedures. A colonoscopy at Mayo cost $1,311, compared to just $573 at Allina specialty clinics and $449 at Fairview clinics in the Twin Cities, according to Minnesota Community Measurement, a state-sponsored nonprofit that tracks cost and quality data. A knee X-ray cost private insurers $92 at Mayo, $69 at Allina and $51 at Fairview.
Those disparities make little sense to business executives such as Angie Carlson. “Even if they bought … top of the line equipment for colonoscopies,” she said, “there still is only one way to do a colonoscopy.”
Mayo’s higher fees partly reflect its market dominance in southeast Minnesota, where it has the clout to command higher payments from insurers. Twin Cities hospitals, for example, discount their rates by 40 to 50 percent in order to be included in the networks of large private insurers, according to data from the Minnesota Hospital Association. Mayo’s hospitals — St. Marys and Methodist — by contrast, discount their rates to private insurers by roughly 20 percent, the data show.
So even when Mayo’s prices are comparable — it charges $10,562 for a knee arthroscopy and Abbott Northwestern Hospital charges $10,424, according to hospital association data — it is possible that Mayo is discounting less and getting more of its sticker price back from insurers.
And that may be taking a toll. Insurance brokers say more customers are willing to sacrifice the cachet of having Mayo in their plan, especially this year, as employers cope with rising premiums taking hold under federal health reform. Individuals and small businesses can now find limited-network plans that exclude Mayo and other higher-cost providers.
“You see fewer people signing up for [plans with] Mayo when they realize what the additional cost is,’’ said Paul Howard, a broker with the DCI agency in Chanhassen, which helps individuals and small businesses select benefits.
Mayo officials say they aren’t seeing the consequences in terms of fewer patients. Mayo treated 1.2 million patients from 135 countries last year, an increase from 2012. They also point to a partnership with Wal-Mart, the world’s largest retailer, which said this fall that it will cover 100 percent of employees’ treatment and travel costs for breast, lung and colorectal cancers if they went to Mayo. And, for 2015, Medica added a plan on MNsure for Rochester-area residents that only covers services provided by Mayo doctors and facilities.
Still, patient choices could shift as consumers make greater use of websites, such as MNsure, that make hospital charges more visible, said Garrett Black, a vice president at Blue Cross and Blue Shield of Minnesota.
“With the level of transparency and consumer choice that is emerging … people are going to choose with their wallets,” he said.
Insurers such as Blue Cross have been trying to steer patients to less expensive hospitals and clinics through “tiered” benefits, which offer financial incentives such as lower coinsurance payments. In Blue Cross’ Distinction program, for example, Mayo shows up as a high-quality provider for cardiac care, knee and hip replacements, and spine surgeries. But it doesn’t receive the “Plus” designation that the insurer awards to hospitals with a combination of high quality and low cost in those specialties.
Similarly, the ranking system used for Minnesota state employees’ health insurance ranks Mayo’s primary care clinics in Rochester among the most expensive, and gives workers financial incentives to choose others.
Costs vs. outcomes
Mayo officials don’t argue with the cost figures. But they say sticker price is a crude measure by which to judge a hospital or clinic.
“Despite the reputation of high cost that some people would try to pin on us, we think we can do pretty well and we are constantly working to do better,” said Dr. Douglas Wood, medical director at Mayo’s center for innovation.
Mayo’s tradition of paying physicians a salary, rather than fees for each procedure, encourages doctors to collaborate, while eliminating the incentive faced by many American doctors to bill for more and more procedures. As a result, Mayo doctors say it’s more likely to make an accurate diagnosis the first time, sparing patients the expense of repeat tests and unnecessary procedures.
Mayo’s neurology department, for example, has developed particular expertise in the diagnosis of multiple sclerosis. In some cases, Mayo doctors found that patients did not have the condition after they had already undergone expensive tests and thousands of dollars in treatments at other hospitals, said Dr. Charles Rosen, a Mayo transplant surgeon.
Organ transplants are another example. Even if Mayo charges more for the initial surgery, its patients suffer fewer deaths and fewer follow-up transplants due to complications, Rosen said.
“If you avoid that [second] one, you save a bunch of money,” he said.
Even the higher price for a standard colonoscopy may be justifiable, according to Dr. Vijay Shah, chairman of Mayo’s gastroenterology department. Mayo doctors conduct more thorough searches and remove dangerous polyps in the first procedure, while other doctors wait until a second procedure, he said. The hospital achieves high success rates, and reduces complications such as perforations of the colon, by funding extensive training for its gastroenterologists before they can fly solo, he added.
“A blood draw, that’s a pretty standard procedure,” Shah said. “But to have a long tube stuck all the way up through your back side? That’s an invasive procedure that requires competence and excellence.”
And where Mayo does charge more per procedure, there is evidence that it simply uses fewer of them.
In a 2008 study, the Dartmouth Atlas of Health Care estimated the United States could save $50 billion annually in spending on end-of-life care if all hospitals operated as efficiently as Mayo, largely because it had found ways to excise waste and unnecessary care. Mayo is now working with other hospitals through Dartmouth to identify savings in nine areas of notoriously wasteful medicine.
“What’s really important about Mayo is that they have shown they can do integrated, high quality care that doesn’t involve a huge quantity of care,” said Jon Skinner, a health economist for the Dartmouth Atlas, which is based at the Dartmouth University medical school in Hanover, N.H. “It doesn’t involve … lots of surgery and lots of procedures and lots of hospital admissions that other hospitals are doing and claiming they need to do.”
Later this year, Minnesota Community Measurement will, for the first time, rank hospitals by the total cost of caring for each patient — rather than the amount charged per procedure. This would theoretically favor a hospital that performs one colonoscopy instead of two, or makes a correct diagnosis the first time.
But Mayo’s CEO, Noseworthy, is warning that this first round of data will end up looking bad for Mayo, because it won’t adequately adjust for the fact that Mayo treats sicker patients.
Innovating for efficiency
When compared to other “destination” medical centers around the country, Mayo does appear more cost efficient. Noseworthy said that, in part, reflects Mayo’s investments in research that makes medical care more efficient.
“Mayo is very strong right now, and we’re in a very strong position to lead going forward,” Noseworthy said, “but to lead one has to innovate.”
A streamlined patient-tracking system in its ICU, for example, has been credited with reducing hospital errors and reduced lengths of stay; it is being tested at five U.S. hospitals and will produce an estimated $80 million in savings over three years.
A tissue-freezing technique in Mayo’s pathology lab produces faster test results, giving surgeons the ability to treat patients in a single procedure rather than wait for lab results and schedule follow-up operations. Improved preparation of patients for orthopedic surgeries has allowed Mayo to reduce the use of intravenous narcotics in recovery, reducing drug costs as well as patients’ hospital stays. A Medicare demonstration project subsequently found Mayo with the lowest costs for hip and knee replacements out of 19 major U.S. medical centers.
“You do things up front that allow the patients really to heal in a natural manner,” said Dr. Robert Cima, a surgeon and chairman of Mayo’s Surgical Quality Subcommittee. “That allows them to feel and act as if they are able to leave” the hospital.
Even large insurers that monitor Mayo’s costs acknowledge these efficiencies. Blue Cross, for one, is exploring the creation of an insurance plan that would include Mayo in specialties where it is clearly superior, such as the diagnosis and care of multiple sclerosis. “The more complex the care is,” Black said, “the more cost effective Mayo becomes.”
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.
By Lola Butcher Hospitals and Health Networks 6.10.14
Purchaser and Provider Collaboratives Bring Increased Transparency
MN (Minnesota) Community Measurement is the oldest and most influential of several regional collaboratives that bring a wide range of stakeholders together to increase transparency into health care quality, patient experience and financial information.
The nonprofit organization, currently chaired by Penny Wheeler, M.D., chief clinical officer of Allina Hospitals & Clinics, introduced MNHealthScores.org in 2009 to allow patients to check out the quality of care delivered at clinics or by medical groups. After the Minnesota Hospital Association joined as a sponsor organization, the website grew to include comparative data on hospital quality, including both process and outcome measures, and patient experience.
“We know that consumers are looking at the information, and we also know that providers are looking at the information and using it to improve the quality of care within their own organizations,” says Tina Frontera, chief operating officer of MN Community Measurement. “One advantage of transparency is that it does help spur improvement efforts.”
MNHealthScores.org collects payments from the state’s insurers and publishes a blended average payment rate for basic services — office visits, imaging services and a few procedures — for each clinic system.
Because it is a blended average, that information is not particularly useful to patients, but it allows payers and purchasers to compare their options — and McCoy, the Fairview Health Services executive, finds it very helpful.
“Our preference is to be at market or below market in our pricing, so that is certainly something that we look at,” he says. “And if there’s an issue with a price being out of line, we want to make sure we address that with the payers.”
Next up: MNHealthScores.org later this year will debut a total cost of care measure — the average total, including hospital, physician, pharmacy and all ancillary providers, for an individual for a year. This will allow a comparison of the total cost of care among provider systems throughout the state — information that purchasers and payers will love to have.
Minnesota health care leaders are building on quality measurement and improvement efforts—including reductions in avoidable hospital readmissions that led to $70 million in savings—to tackle the important, but tough, task of measuring how much an individual health care episode costs. These efforts are led by MN Community Measurement, one of RWJF’s Aligning Forces for Quality communities, which has convened disparate health care stakeholders over the years to measure everything from the management of diabetes to the patient experience.
This program is a part of a larger effort by Aligning Forces for Quality to boost the overall quality of health care in communities across the country and provide models for national reform.
When Americans go to the doctor, it’s essentially a coin toss as to whether they’ll receive the care medical experts recommend for their conditions. Measuring the quality of care is a critical starting point to close these gaps. After all, we cannot improve what we do not measure. Publicly reporting about the performance of physician practices allows patients to make informed choices about their care, helps health care professionals see where they can improve, and allows purchasers to know the value of the care they are buying.
This issue brief examines lessons from RWJF Aligning Forces for Quality alliances that have made information about the quality of care local physicians provide publicly available to everyone who gets, gives, or pays for care.
MN Community Measurement, an Aligning Forces for Quality alliance, measures and publicly reports provider performance data. State practices and hospitals, including Entira Family Clinics, are using these data to inform efforts to improve care and patient outcomes for conditions including depression and diabetes.
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.
Ratings on nearly 500 adult and child primary care practices based on patient experience.
Ratings on 552 medical practices based on their success at helping patients achieve key targets in managing cardiovascular disease and diabetes.
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.
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.
“The latest Health Care Disparities Report should be a call to action for the health care community to ensure all Minnesotans receive the health care they need. While we are heartened to see improvement in some areas for public program enrollees, there is much more work to do to close these gaps. Providers need to be held accountable for gaps in care that affect public program enrollees and people of color, and we will work with the health plans we contract with to address these disparities with providers. We are turning to the Cultural and Ethnic Communities Leadership Council to help keep us all focused on these issues and to identify solutions.”
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.”
By Donovan Slack, USA TODAY/ Gannett Washington Bureau
Updated 9:39 a.m. CDT May 5, 2014
WASHINGTON – 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/