My surgeon made how much?

If you look up arthroscopic knee surgery on the new Blue Cross cost estimator,  you'll see that several Charlotte surgeons were reimbursed about $4,000 for doing the procedure at Charlotte Surgery Center and about $10,000 for doing it in area hospitals.

But what you take from that depends on your perspective.

Murrey

Dr. Dan Murrey,  CEO of OrthoCarolina,  says it's an accurate representation of the savings many patients can find by avoiding a hospital for routine surgery.  Now that so many patients are picking up thousands of dollars out of pocket,  he hopes they'll start asking questions to ensure they don't pay extra.

But he's appalled at the idea that patients will think their doctors tacked on an extra $5,000 or $6,000 at the hospitals.  Even though the Blue Cross listings are attached to surgeon's names,  the average reimbursement represents all costs of a procedure, such as medications, anesthesia and hospital fees.  All things being equal,  he said, the surgeon makes the same amount at either setting  --  and it's lower than the $4,000 being reimbursed at the ambulatory surgical center.

Executives at Carolinas HealthCare System and Novant Health agree it's good for patients to know that a hospital may be more costly for a routine procedure. But if you're coming in with risk factors, such as heart trouble or a history of problems with anesthesia,  that routine procedure could quickly turn scary.  In those cases the hospital's resources are essential. They say hospitals and doctors that are averaging bigger reimbursements from Blue Cross may just be those that are taking on a bigger load of high-risk patients whose procedures are more complicated.

Leslie Goldfarb,  who has been looking into arthroscopic knee surgery,  says the average reimbursements listed in that public database provide better information than Blue Cross customers like her can get from the customer-only cost tool.  That's not a compliment to her insurance company.  She wonders why Blue Cross doesn't provide a better service to its customers,  instead of focusing on national attention-getting moves like the public release.

"The cost estimator on their member website is vague, incomplete and very, very slow!" she emailed. "The tool that you have published is fast as lightning, lists many more providers and is much easier to use."

Blue Cross NC public relations manager Michelle Douglas says the personalized estimates generated by the member search are more complex than the averages listed on the public tool, and thus take longer even under ideal circumstances.  "It is true that the customer tool is not running as quickly as we like right now, and we are working with our external vendor to understand why,"  Douglas said Tuesday.  But she said that tool still provides more and better information for a personal decision than the public list.

Shortly after Blue Cross and Blue Shield of North Carolina released its public database,  Blue Cross put out a national report on costs for hip and knee replacement,  highlighting the wide variation in cities such as Charlotte.

"In order to address healthcare costs and access, it is important that consumers, employers and industry leaders have information on these price variations and are provided the tools to become well informed healthcare shoppers,"  that report says.  It says this is the first report in a series  "that will utilize a market-leading medical claims database to uncover key trends and provide insight into healthcare dynamics."

Blue Cross clarifies NC cost tool

When Blue Cross and Blue Shield of North Carolina unveiled a new online cost tool last week, the immediate concern raised by national experts and Charlotte health executives was that it wasn't clear what the numbers mean.

Blue Cross spokeswoman Michelle Douglas said Monday the company has added an explanation:  Cost estimates are averages based on historical BCBSNC claims data. Amounts listed typically include physician fees, facility fees and costs for things like anesthesia, drugs, medical supplies – as well as customer responsibility (deductible, co-pay and co-insurance). Your actual costs may be different based on variations in these factors as well as your health plan design, deductibles/co-insurance and out-of-pocket limits.

"The fact that hospitals say the numbers are Greek to them is indicative of why the tool was necessary,"  Douglas said in an email.  "Before, customers had no place to go and ask how much the total cost (physician fee, hospital fee, labs, anesthesia, etc.) of a health care procedure might be."

Meanwhile,  John Murawski with the News & Observer forwarded a message noting that UnitedHealthcare offers cost estimates to the public on its Health4Me mobile app  (it's free on for Apple or Android devices,  or see an online demonstration).

The UnitedHealthcare guest function lists estimates  "based on local market average costs,"  rather than breakdowns by provider,  as the Blue Cross tool does.  (UnitedHealthcare, Blue Cross and many other insurance companies offer more detailed members-only data,  including what patients can expect to payout of pocket based on their plan.)   I looked up knee replacement,  which the Blue Cross tool listed as ranging from $20,154 to $40,148 in the Charlotte area.  On Health4Me I got a Charlotte average of $60,185  ($59,125 for the procedure itself,  with the rest for pre- and post-surgical office visits and physical therapy).

So we're all starting to get a peek behind the curtain of health care costs.  But making sense of it is going to take a lot more work.