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Should Costs Matter in Your Decision-Making? Laura Medford-Davis, MD Robert Wood Johnson Clinical Scholar University of Pennsylvania Emergency Medicine
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Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Apr 13, 2017

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Page 1: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Should Costs Matter in Your Decision-Making?

Laura Medford-Davis, MDRobert Wood Johnson Clinical Scholar

University of Pennsylvania Emergency Medicine

Page 2: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Key Takeaways

1. We spend A LOT on healthcare2. Costs affect our patients

Page 3: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Outline

1. How much does it cost?2. Cost Trends3. Impact on your patients4. Value

Page 4: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

MedScape Emergency Medicine Physician Compensation Report 2012.

Page 5: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Do You Know How Much We Charge?

$1000-2000 $2000-3000 $3000-4000 $>40000.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

CT Abdomen and Pelvis with Contrast

Page 6: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Do You Know How Much We Charge?

$1000-2000 $2000-3000 $3000-4000 $>40000.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

$5,620

CT Abd $2,876 CT Pelvis $2,317 IV Contrast $178 Gastroview $29.80 Physician Fee $219 Total $5,620

CT Abdomen and Pelvis with Contrast

Page 7: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Do You Know How Much We Charge?

• Median Charge for ED Visit: $1,233– Kidney Stone $3,437 (Range $128 - $39,408)– Cold/URI $740 (Range $19 - 17,421)

Hsia et al. PLoS ONE 2013.

Page 8: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Wild Variations

Dartmouth Atlas

Page 9: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Typical ER Bill-Facility ChargesService Quantity Total ChargeLevel 4 ER Visit 1 $954Conscious Sedation 1 $22Ankle XR 2 $586BMP1 $199CBC 1 $133Coags PT 1 $15Coags PTT 1 $108Dilaudid 1mg/ml 4 $12.16Propofol 10mg/ml 2 $19.20IV Push 2 $136

TOTAL $2,184.36

Page 10: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Typical ER Bill-Professional ChargesService Quantity TotalLevel 4 ER Visit 1 $329Conscious Sedation 1 $200Ankle XR 2 $116Lower Leg Splint 1 $475

TOTAL $1,120

Page 11: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Typical ER Bill-CostsTOTAL $2,184.36Medicare -$424.85Insurance Adjustment -$1,657.12

Patient Responsibility $102.39

Page 12: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Profit Margins by Payer

Series1

-60

-40

-20

0

20

40

60

PrivateMedicareMedicaidUninsured

Perc

ent

Page 13: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Outline

1. How much does it cost?2. Cost Trends3. Impact on your patients4. Value

Page 14: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

We Spend…A Lot

• $2.7 Trillion

• $8,680

• 17.9%

• 21.8%

Page 15: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

We Spend…A Lot

• $2.7 Trillion – spent in the US in 2011

• $8,680 – per American

• 17.9% - Percent of GDP

• 21.8% - Spent on top 1% of patients

Page 16: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Carton of Eggs

$3

Page 17: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Carton of Eggs

$55

Page 18: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Centers for Medicare and Medicaid Services 2013.

Page 19: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Centers for Medicare and Medicaid Services 2013.

What Are We Paying For?

Page 20: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Outline

1. How much does it cost?2. Cost Trends3. Impact on your patients4. Value

Page 21: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Insurance Premium Prices are Rising

Kaiser/HRET Survey of Employer-Sponsored Health Benefits

Page 22: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Healthcare Spending for a Family with Average Income $66,570

Premium Contribution $3,100Out-of-Pocket Costs $1,952Tax contributions to government health programs $4,664Foregone Wages $6,482

TOTAL $16,198

Polsky D, Grande D. N Engl J Med 2009;361:437-439.

Page 23: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Kaiser Family Foundation from AHRQ-MEPS Table 1.1

Out-of-Pocket Spending up 73%

Page 24: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Increase in High-Deductible Plans

Kaiser/HRET Survey of Employer-Sponsored Health Benefits 2012

Page 25: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium
Page 26: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Effects on Patients

• 41% have trouble paying medical bills• Medical bills are the #1 cause of bankruptcy– 3 in 5 bankruptcies

Commonwealth Fund Health Insurance Survey 2012

Page 27: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium
Page 28: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Outline

1. How much does it cost?2. Cost Trends3. Impact on your patients4. Value

Page 29: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Quality x AccessVALUE = ------------------------

Cost

Page 30: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

↑Health↑Patient Experience↓Costs

Triple Aim for Healthcare Improvement

Page 31: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Choosing Wisely

1. CT Head for low-risk head injury2. CT Head for Syncope and normal neuro exam3. CT A/P for kidney stones4. Foley Catheters5. Wound cultures for I&Ds6. IVF for kids without PO challenge7. CT PE if PERC Negative8. Spine imaging for low back pain9. Antibiotics for sinusitis10.Futile end-of-life care in the ED

Page 32: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

The Future• Increased Price Transparency• CMS Paying for Value• ACA Exchange Plans– Narrow Networks– Higher deductibles

Page 33: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Key Takeaways

1. We spend A LOT on healthcare2. Costs affect our patients3. The future is moving toward Value

Page 34: Should costs matter in healthcare decision making?- 2015 Policy Prescriptions® Symposium

Questions