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."

Author: GOP needs strategy beyond anti-Obamacare

I know a lot of Republicans want to repeal the Affordable Care Act,  but I've had a hard time figuring out what,  if anything,  they want to take its place.  That's unfortunate,  given the power they hold in North Carolina and in Congress.

Klein

Philip Klein,  commentary editor for the conservative Washington Examiner,  agrees.  "If opponents of the law want to win the war over the future of the nation's medical system,  they will have to unite around an alternative approach,"  he writes in  "Overcoming Obamacare:  Three Approaches to Reversing the Government Takeover of Health Care."

Klein argues that there's not really a dearth of GOP alternatives.  Instead,  he says,  there are too many  --  and all of them tend to get drowned out in general discourse by the  "repeal"  rhetoric.

Health reform has never been a favorite GOP issue,  except for opposing expansion of government's role,  Klein writes.  You can fire up a conservative crowd by talking about tax cuts,  gun rights,  immigration or the war on terror,  he says,  but don't expect to get cheers for talking about tax treatment of health insurance.

"When Republicans utter phrases such as  'repeal and replace,'  what conservatives often hear is  'Obamacare Lite.'  As a result,  the prevailing question on the right often becomes,  'Why can't we just repeal the law and be done with the health care issue?'  The answer is that even if simple repeal were politically obtainable,  Americans would still be left with a broken health care system."

Klein groups the alternatives into three camps:  Reform,  replace and restart.  I'll loop back to these options.  For now, I'll settle for noting that Klein,  like many of other political perspectives,  believes more and better information about the cost of health care is essential.  "Give consumers the motivation they need to save money and the information they need to do so,  and suppliers of goods and services will respond by providing better value,"  he writes.  "For the most part,  neither feature exists in the American health care system."

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.

Ex-doctor, now 'navigator,' launches Obamacare blog

John Scherr isn't your typical Obamacare volunteer.

Nor is he your typical doctor,  medical administrator,  small business owner or individual  insurance customer.  It's his combination of experiences that led the recently retired Charlotte physician to create a blog that delves into the potential and problems of  the Affordable Care Act.

Scherr

"I don’t believe that healthcare – or medical insurance — is a right that we as Americans are necessarily born with, an inalienable right such as the right to 'life, liberty, and the pursuit of happiness,' as stated by Thomas Jefferson,"  Scherr writes in Lakeside Medical Musings  (a reference to his home on Lake Wylie).  "However – and this is a BIG however –  I do believe that, as the wealthiest nation in the world, we as a country have an obligation to provide quality, comprehensive healthcare to all of our citizens, and the cost of that healthcare must be affordable for all. No one in this country should have to pass on seeing a physician to treat their diabetes, hypertension, or cancer because they need to buy food for their family.  That’s just wrong."

Scherr says he's been interested in ways to rein in health care costs since his days in a private internal medicine practice in Atlanta in the 1980s,  when HMOs were the rage.  He volunteered to take part in one of the early  "capitation"   contracts,  in which doctors are paid by the patient,  rather than collecting a fee for each office visit,  procedure and test.

About 20 years ago,  he was part owner of a business with about 100 employees.  There,  he says,  he learned the challenges of huge annual premium increases,  which often meant switching providers and forcing employees to change doctors.

When he came to Charlotte,  he worked as a hospitalist  (a doctor who sees patients only while they're in the hospital)  for Carolinas HealthCare System and got involved in administration of that group.  And when he started thinking about retirement,  he got an eye-opening look at what it would cost to buy his own insurance,  an experience he writes about in a post titled  "Obamacare and Me."   This year he helped his two adult daughters buy insurance policies on the federal exchange created by the Affordable Care Act,  and that's where he expects to get his own insurance  (without subsidy)  in 2015.

Scherr recently took the 30-hour training to become an ACA health insurance navigator;  he has started volunteering with the nonprofit Enroll America.  He's tapping that experience for a series of posts on the twists and turns of our nation's health insurance revolution.

A self-described liberal Democrat,  Scherr writes that he was deeply disappointed by the compromise that won Congressional approval,  modeled largely on conservative plans.  But he says his interest now is on getting past the political rhetoric of the left and right to explore the reality of what's happening and what's to come.  He writes that he sometimes feels like a Republican as he learns to value the free-market competition between insurance companies:  "This competition will encourage, for the first time, health insurance companies to lower medical costs.  If they have lower costs, they will be able to offer lower premiums, and thus receive a higher market share.  ...  All that’s needed now is to get Amazon involved in the health insurance delivery business, and the problem will be solved entirely."

Scherr says he hopes his blog will help people understand how to get better,  less costly health care.  He'd also like to encourage policymakers to join him in open-minded exploration.

"Republicans just want to vote to repeal the law,  and Democrats don’t want to admit that there is anything in the law that needs to be changed,"  he writes.  "There is more than enough blame to go around,  and there are plenty of improvements that need to be made.  Hello, Congress? Pay attention to your constituents! Get it together and do your job! Debate,  argue,  defend,  parry – but at the end of the day,  COMPROMISE and come up with some solutions that are not so fundamentalist in nature that only the hard-wingers on both sides are heard." 

Expert: Pain coming for N.C. businesses, workers

Employees can expect to see more high-deductible health policies as employers try to control costs,  a health researcher and former journalist told members of the Charlotte Chamber today.

Connolly

And North Carolina's economy will suffer from state lawmakers'  decision not to take federal money for Medicaid expansion,  said Ceci Connolly, managing director for PricewaterhouseCoopers' Health Research Institute.

"It's not a political commentary,"  said Connolly, a former health correspondent for the Washington Post and author of a book on the Affordable Care Act.  "It's pure dollars and cents."

Connolly was a keynote speaker at the Charlotte Chamber's health care summit,  which drew about 450 people to the Westin Hotel.  The event marked the chamber's Healthy Charlotte fitness campaign and its push to market Charlotte as a national health care destination for patients and businesses.

Hospitals,  doctors' offices and other health care businesses employ more than 116,500 people in the Charlotte region and generate more than $6.2 billion in annual wages,  the chamber reported.

But Connolly said those businesses lost out on  "a serious revenue opportunity"  when the state refused the  "Obamacare"  offer to expand Medicaid coverage for low-income residents with federal money.  North and South Carolina are among 21 states that opted not to participate this year,  leaving 689,000 low-income N.C. residents in a  "Medicaid gap" without coverage.

"Your industries are suffering because you're not getting the increased business,"  she said.

Update: An editorial in the News & Observer offers more details on the cost of refusing the Medicaid expansion.

Benjamin

Fellow panelist Dr. Georges Benjamin,  executive director of the American Public Health Association,  agreed that wasn't a smart business decision:  "Business people know the first principle of business is not to leave one dime on the table."

Benjamin,  a physician and former Maryland health secretary,  told the chamber crowd that federal Medicaid money could have been used to improve mental health services,  a need described earlier in the session by Dr. John Santopietro of Carolinas HealthCare System.  "The beauty of Medicaid is it is run by the states,"  Benjamin said.  "They can do this.  The governors can be creative."

Several local speakers talked about efforts to control health care costs while improving care.  Connolly said she expects to see employers take a leading role in coming years.  One likely strategy,  she said,  is a continuing shift to high-deductible policies that hold down premiums by requiring patients to pay a bigger chunk of medical bills from their own pockets.  Such policies force employees to think about spending their own money more wisely,  Connolly said.

Technology is likely to play a role in helping patients take charge of their own health,  from insurance companies offering online cost comparisons to a burgeoning industry in devices that monitor vital signs and exercise, several speakers said.  Connolly,  who was wearing a wristband that monitors her steps,  said she envisions a day when that data would feed to her doctor's office so the doctor would be aware of changes in activity.