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Are Patients Becoming Price and Quality Sensitive?

Posted on October 20, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yesterday I was watching the live stream of Jonathan Bush, CEO of athenahealth speaking and then on a panel at US News’ Hospital of Tomorrow event. Jonathan Bush was as good as ever and offered some really amazing insights into the changing culture of health care as we know it. He also introduced the website along with the ZDoggMD Jay Z parody video called EHR State of Mind.

At one point in the panel discussion he made a point that really stuck with me. He suggested that a few years ago you could cut the price of your services in half and you’d still get the same number of patients in your office. Then he said that you could double the price of your services and you’d still get the same number of patients. He went on to say that you could provide better care to your patients and you’d still get the same number of patients.

Certainly that’s not a direct quote, but you get the gist of what he’s saying. Essentially, a few years back patients weren’t price or quality of care sensitive. Sure, maybe on a really macro scale some really doctors would be found out, but for the most part patients didn’t care what the price of healthcare was since they just paid the co-pay and they had no way of knowing the quality of care the doctor provided.

Jonathan suggested that over the past couple years this has started to change. Patients were becoming more price and quality of care sensitive. He didn’t explain why this is the case, but I’d suggest that it’s due to more availability of information and high deductible plans.

I think this shift in how patients select their healthcare is going to have wide ranging impacts on the health care system. Michael Robinson, Vice President, U.S. Health and Life Sciences, Microsoft, was on the panel with Jonathan Bush and suggested that technology was the enabler for a lot of these changes. That’s not true for all of the changes, but no doubt it plays a role in a lot of them.

Consumers Are Still Held Back From Making Rational Health Decisions

Posted on November 25, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Price and quality of care–those are what we’d like to know when we need a medical procedure. But a perusal of a recent report from the Government Accountability Office reminded me that both price and quality information are hard to get nowadays.

This has to make us all a little leery about trends in health reform. Governments, insurers, and employers want us to get choosy about where we have our procedures. They justify rises in copays and deductibles by saying, “You patients should start to take responsibility for the costs of your own health care.”

Yeah, as responsible as a person looking for his car keys in the dark. Let’s start with prices, which in many countries are uniform and are posted on the clinic wall.

Sites such as Clear Health Costs and Castlight Health prove what we long knew anecdotally: charges in the US vary vertiginously among different institutions. Anyone who had missed that fact would have been enlightened by Steven Brill’s 2013 Time Magazine article.

But aspirations become difficult when we get down to the issue at hand–choosing a provider. That’s because US insurance and reimbursement systems are also convoluted. We don’t know whether a hospital will charge our insurer their official price, or how much the insurer will cover. It might feel righteous to punish a provider with high posted prices (or prices reported by other consumers), but most patients have a different goal: to keep as much of their own money as they can.

We can gauge the depth of the cost problem from one narrow suggestion made in the GAO report that yet could help a lot of health consumers: the suggestion that Centers for Medicare & Medicaid Services (CMS) publish out-of-pocket expenditures for Medicare recipients as well as raw costs of procedures (page 31). Even this is far from simple. HHS pointed out that 90% of Medicare patients have supplemental overage that reduces their out-of-pocket expenditures (page 43). Tracking all the ancillary fees is also a formidable job.

Castlight Health is out in front when it comes to measuring the real impact of charges on consumer. They achieve great precision by hooking up with employers. Thus, they know the insurer and the precise employer plan that covers each individual visiting their site, and can take deductibles, exclusions, and caps into account when calculating the cost of a procedure. A recent study found that Castlight users enjoyed lower costs, especially for labs and imaging. Some nationwide system built around standards for reporting these things could unpack the cost conumdrum for all patients.

Let’s turn to quality. As one might expect, it’s always a slippery concept. The GAO report pointed out that quality may be measured in different ways by different providers (page 26). A recently begun program releases Medicare data on mortality and readmissions, but it hasn’t been turned into usable consumer information yet (pages 27-28). Two more observations from the report:

  • “…with the exception of Hospital Compare, none of CMS’s transparency tools currently provide information on patient-reported outcomes, which have been shown to be particularly relevant to consumers considering common elective medical procedures, including hip and knee replacements.” (Page 21)

  • “CMS’s consumer testing has focused on assessing the ability of consumers to interpret measures developed for use by clinicians, rather than to develop or select measures that specifically address consumer needs.” (Page 25)

Some price-check sites simply don’t try to measure quality. A highly publicized crowdsourcing effort by California radio station KQED, based on the Clear Health Costs service, admitted that quality measures were not available but excused themselves by citing the well-known lack of correlation between price and quality.

Price and quality may not be related, but that doesn’t relieve consumers of concerns over quality. Can you really exchange Mount Sinai Hospital in New York for Daddy-o’s Fix-You-Up Clinic based on price alone? Without robust and reliable quality data, people will continue choosing the historically respected hospitals with the best marketing and PR departments–and the highest prices.

A recent series on health care costs concludes by admonishing consumers to “get in the game and start to push back.” The article laments the passivity of consumers in seeking low-cost treatment, but fails to cite the towering barriers that stand in the way.

The impasse we’ve reached on consumer choice, driven by lack of data, reflects similar problems with analytics throughout the health care field. For instance, I recently reported on how hard a time researchers have obtaining and making use of patient data. Luckily, the GAO report cites several HHS efforts to enhance their current data on price and quality. Ultimately, of course, what we need is a more rational reimbursement system, not a gleaming set of computerized tools to make the current system more transparent. Let’s start by being honest about what we’re asking health consumers to achieve.

Medical Bills, Patient Portal Insight and HIT Friends in Need

Posted on August 15, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

HIT Friends Support a Great Cause
Blogging and social networking are of course great drivers of information and thought leadership, and they can also be very effective in spreading the word of friends in need. I found out through these avenues about the healthcare challenges of three-year-old Little James, recently diagnosed with a brain tumor, and the fundraising efforts of Todd Stein at Amendola Communications to alleviate the burden of his mounting medical bills. You can read about his healthcare challenges here. Prayers and donations are immediate needs. I wonder if any organization out there might step up and match donations.

Speaking of Medical Bills
On a lighter note (sort of), I laughed out loud when I saw an explanation of benefits for my recent surgical procedure.


Thankfully, I do not truly owe anywhere near that amount due to insurance coverage. I shudder to think how the uninsured pay for life-saving procedures they can’t afford. Yes, hospitals can work out monthly payment plans for anyone, but if an extra $50 a month means less gas in the tank to drive your kids to school … I now find myself tediously combing over statements from the hospital and explanation of benefit statements from my insurance company to make sure they match up.

More Healthcare Cost Transparency News
A company called Change Healthcare is getting into the cost transparency game, having just secured $15 million in funding to further develop its Transparency Messenger product, which, according to the company, compiles health plan and claims data to devise algorithms that determine cost of service. It then uses health plan holders’ or employees’ demographic information and personal preferences for care to look for savings.

Customer Service in Healthcare
In contrast to the financial distress that comes with unexpected medical procedures, I must share with you a thank you note from my surgical team. While I appreciate the gesture, I’m wondering if they’ve charged me for it!


All kidding aside, this gesture highlights the increasing importance providers are placing on customer service. To learn more, check out “Why Customer Service Matters in the Healthcare Industry,” by James Merlino, MD, of the Cleveland Clinic.

Patient Portal
I haven’t yet logged back into my patient portal – thankfully having no need to right now. My last doctor’s visit prompted me to ask if I could access my latest pathology report via the portal. My doctor sidestepped the question and promptly presented me with a paper copy, which will likely be a good thing, as he and my dermatologist don’t seem set up to share patient information electronically. That seems to be a provider choice, and not necessarily due to poor portal design.

Speaking of patient portals, I highly recommend you take a look at Dr. Michael Koriwchak recent blog over at “My First Year with a Patient Portal” gives us patients a better idea of what works and what doesn’t from the practice perspective.