Transcript Slide 1

COST CONTAINMENT INITIATIVE
Dining Associates Day August 2013
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).
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What can you do?
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When you are in need of medical care, know where to go: try
the UNH Employee Clinic
Ask if a generic prescription is right for you
HPHC members participate in the Tandem Care Health
Shopping Program
Do your research
Ask questions
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http://www.kaiserhealthnews.org/stories/2013/may/19/with-high-deductible-plans-it-pays-to-shop-around-forcare.aspx
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http://www.nhhealthcost.org/costByProcedure.aspx
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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 Hospital
http://www.nhha.org/for-patients/hospitalaccessplus
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Hospital billing error vastly overcharges NH woman
Portsmouth 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.
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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
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http://www.choosingwisely.org
American Board of
Internal Medicine
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
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When to call Tandem Care

When your doctor schedules you for:
 MRI
 Colonoscopy
 CT Scan
 Outpatient surgery
 Mammogram
 Lab tests
 Ultrasound
 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.
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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
Rochester: $4,000
Stratham, free standing
facility: $2,300
$1,700
$200
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
Dover: $297
UNH Employee Clinic:
$43
$254
$75
Colonoscopy & Upper
GI Endoscopy
MRI
X-ray
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Does Lower Cost = Lower
Quality?
Quality Indicator
Facility A Facility B Facility C Facility D
Price of Colonoscopy $1,300
$1,415
$2,345
$2,355
National
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
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.
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Be a smart health care shopper.
Save money.
Earn cash rewards.
The choice is yours.
When your doctor schedules you for an
outpatient test or procedure,
call or email Tandem Care:
866-797-4100
Monday to Friday
8:30 to 5:00 (Eastern)
[email protected]
Online at www.tandemcare.com
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Contact Information
Amy Schwartz, MPH
Project Director
[email protected]
Office: 603-862-5099
Mobile: 603-502-4126
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