COST CONTAINMENT INITIATIVE Dining Associates Day August 2013.

COST CONTAINMENT INITIATIVE

NH Provider pricing variation (billed charge)

Service Provider Price A Provider Price B Provider Price C

Normal delivery $12,565 (WDH) $16,313 (Portsmouth) $17,525 (Exeter)

Office visit (age 50-65)

$86 (Portsmouth Family Practice)

$116 (Mill Pond Family Practice)

$167 (Dover Internal Medicine)

Emergency room visit, minor

$204 (Exeter) $552 (WDH) $772 (Frisbie)

Mammography $483 (Women’s Life Imaging)

$519 (Portsmouth) $766 (WDH)

Hernia repair, OP $10,545 (Exeter) $15,537 (WDH) $17,784 (Portsmouth)

MRI, knee, OP $1,916 (Exeter) $3,600 (WDH) $3,808 (Portsmouth)

NH Insurance Dept. Data based on patient experience between December 1, 2010 through February 29, 2012 Dining Associates Day August 2013

Cost Containment Nationally• Hip replacement for 62-year old woman ranged from

$11,000-$126,000 and 15% of the 122 hospitals contacted were unable to provide a cost estimate at all (JAMA Internal Medicine, 2/11/13)

• In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000 (New York Times, 5/8/13).

• In New York, a patient spent three days in White Plains Hospital after a food poisoning outbreak that sickened more than 100 people. Thanks to insurance coverage by United HealthCare she owed only $8.00. Still, she was baffled by the charges: $6,844, including $546 for six liters of saline that cost the hospital $5.16 (New York Times, 8/25/13).

Dining Associates Day August 2013

1. When you are in need of medical care, know where to go: try the UNH Employee Clinic

2. Ask if a generic prescription is right for you3. HPHC members participate in the Tandem Care Health

Shopping Program4. Do your research5. Ask questions

What can you do?



http://www.kaiserhealthnews.org/stories/2013/may/19/with-high-deductible-plans-it-pays-to-shop-around-for-care.aspx



http://www.nhhealthcost.org/costByProcedure.aspx


http://www.nhhealthcost.org/costByProcedure.aspx

HospitalAccess Plus

The following hospitals offer a 15% discount to patients without insurance:• Concord Hospital• Dartmouth-Hitchcock Medical Center• Elliot Hospital• Exeter Hospital• Frisbie Memorial Hospital• Portsmouth Regional Hospital• Wentworth Douglass Hospitalhttp://www.nhha.org/for-patients/hospitalaccessplus


http://www.nhha.org/for-patients/hospitalaccessplus

Hospital billing error vastly overcharges NH womanPortsmouth Herald, October 09, 2011

A New Hampshire woman just couldn’t believe the nearly $2,000 bill she received for a bottle of antibiotic pills was right, so she persisted in demanding answers.In the end, it turned out that Susan Chamberlin should have been charged $382.50 by Portsmouth Regional Hospital. Chamberlain says she was shocked when she first got the $1,912.50 bill for a bottle of cefuroxime pills given to her daughter during emergency treatment.


Ask for Generic Substitution


Brand Name Cost Per Day/Month

Generic Cost Per Day/Month

Zocor (cholesterol)

$4.97/$149.02 Simvastatin $0.15/$4.50

Nexium (heartburn) $6.89/$206.70 *Omeprazole (generic Prilosec)

$0.34/$10.16

Effexor XR (depression)

$6.12/$183.49 Venlafaxine $1.33/$39.94

Fortamet(diabetes)

$19.92/$597.53 Metformin XR $0.23/$6.81

American Board of Internal Medicine

http://www.choosingwisely.org

Created a list of medical tests and treatments you may not need:• Antibiotics for a sinus

infection• A stress test with no sign

of heart disease• Imaging for lower back

pain• Antibiotics for pink eye• PET or CT scans for cancer

in healthy people• Imaging for uncomplicated

headache• Pre-operative chest x-rays

for patients with unremarkable history


http://www.choosingwisely.org/

http://www.choosingwisely.org/

When to call Tandem Care

When your doctor schedules you for:

MRI

CT Scan

Mammogram

Ultrasound

Colonoscopy

Outpatient surgery

Lab tests

Other outpatient tests and procedures

These are just examples. You can call about any outpatient test or procedure ordered by your doctor.

Be sure to call before your appointment so Tandem will have time to reschedule with the low cost provider you choose.


Tandem Savings Examples

Service Ordering Provider Lower Cost Provider Difference Tandem Reward

Physical Therapy Dover: $1,400 Dover, free-standing facility: $800

$600 $100

Colonoscopy Exeter: $2,339 Stratham, free standing facility: $705

$1,634 $200

Colonoscopy & Upper GI Endoscopy

Rochester: $4,000 Stratham, free standing facility: $2,300

$1,700 $200

MRI Dover: $3,553 Portsmouth NH free standing facility: $632

$2,921 $200

Lab test Dover: $388 UNH Employee Clinic: $94

$294 $75

Lab test Rochester: $652 UNH Employee Clinic: $119

$534 $100

X-ray Dover: $297 UNH Employee Clinic: $43

$254 $75


Does Lower Cost = Lower Quality?

Facility A Facility B Facility C Facility D NationalPrice of Colonoscopy $1,300 $1,415 $2,345 $2,355 Average

Objects accidentally left in the body after surgery (per thousand patients)

0.000 0.000 0.000 0.000 0.026

Air bubble in the bloodstream (per thousand patients)

0.000 0.000 0.000 0.000 0.003

Blood infection from a catheter in a large vein (per thousand patients)

0.447 0.000 0.888 0.718 0.367

Qua

lity

Indi

cato

r

source: www.hospitalcompare.hhs.gov/hospital-search


Example: Leapfrog’s Highest scoring hospital in DC is Sibley Memorial, which earned an “A” yet lists charges of about half of the highest-priced hospitals in the region.

Be a smart health care shopper.

When your doctor schedules you for an outpatient test or procedure,

call or email Tandem Care:

866-797-4100

Monday to Friday8:30 to 5:00 (Eastern)

[email protected]

Online at www.tandemcare.com

Save money.Earn cash rewards.The choice is yours.


mailto:[email protected]

Contact Information

Amy Schwartz, MPHProject [email protected]: 603-862-5099Mobile: 603-502-4126

mailto:[email protected]

COST CONTAINMENT INITIATIVE Dining Associates Day August 2013.

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