Dr. H. Lee Adkins talks with a reporter at his practice, Fort Myers (Fla.) Family Medicine. Adkins recently changed his Web site, posting what he charges for everything from office visits to lab work.
It used to be that doctors posted fees on their office wall.
Then came Medicare and health insurance, and no one knew what doctors were charging, what insurers were paying and what patients were getting for their premiums.
Enough, decided Dr. H. Lee Adkins, a primary care physician who runs Fort Myers Family Medicine in Florida.
Adkins recently changed his Web site, posting what he charges for everything from office visits to lab work. For example, an initial office visit can run from $75 to $100 or $125, while lab work varies from $8 for a glucose blood test to $100 for the human papilloma virus.
His move is part of a national push toward greater transparency in health care, as more Americans go without health insurance and there’s expected to be an uptick in people moving into high-deductible health plans that force consumers to consider the cost of services.
Thirty-three states, including Florida, so far have some sort of laws requiring price transparency, according to the Deloitte Center for Health Solutions. Some medical and policy experts believe greater transparency will lower care costs.
“What triggered it with me is when I started seeing everyone laid off,” Adkins said.
Nationally, 47 million Americans are without insurance, according to industry reports. The figure is likely to grow as the economy slides. Fearing the cost of care, many who are uninsured won’t seek help until their conditions land them in emergency rooms.
Adkins then started considering the number of Americans who are expected to move into consumer-driven health plans – high deductible, low-premium products that are generally linked to a medical savings account or reimbursement agreement. Twenty-four million Americans were enrolled in consumer-driven plans as of January 2006, according to the Government Accountability Office, the latest data available.
Competition factored into Adkin’s decision, too. He said small practices such as his need an edge.
He dropped prices for patients paying out of pocket by 30 to 35 percent. The cuts don’t hurt his business because insurers don’t pay the full amount and take months to send the check and the whole process uses staff time that could be directed elsewhere.
“(Transparency) opens the door to these millions of people who do not have insurance or have those health savings plans,” Adkins said.
Emily Pease, 25, of Fort Myers and her husband dropped out of their health plan when the premium got too expensive. She’s a hairdresser; he’s in construction. Their two children remain on the policy.
“I can’t afford my own health insurance, so it helps me know what I’m paying,” said Pease, a patient of Adkins’.
Other doctors are being up front with patients about pricing, in some cases because they’ve quit dealing with insurance companies.
Dr. Kirk Hintz, an emergency physician, and his partners opened an urgent care clinic in Naples, Fla., in 2004. The clinic is open seven days a week and the prices set at about half of the typical rate for urgent care. The trade-off: The doctors won’t take private insurance.
“I can’t run a business with my money tied up in claims for six months to a year,” Hintz said.
Patients sometimes walk out when they see the full-pay policy, Hintz said. But many have embraced the concept, he said. Managers at one area farm bus workers to the clinic for care because it’s cheaper to do so and to pay in cash than it is to file worker’s compensation claims, Hintz said the company told him.
Insurance companies have a stake in price transparency, too.
Humana, for example, lets clients search its Web site for price and quality information for hospital and outpatient centers, spokesman Mitchell Lubitz said. The company plans to add information on individual physicians soon. Most other major insurers are doing the same, he said.
“The only way we can manage cost is to get the employer and employee involved in the selection and use of their health care,” Lubitz said. “Health care is that last sector of the economy where the consumer is not at the center of the buying process and where info about the cost and quality of the service is not readily available.”
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Up-front billing not simple
Moving toward transparency in health care can be complicated.
Issues for doctors
• Doctors must make sure they aren’t violating any contracts with insurance companies, some of which say doctors can’t charge anyone less than what they bill them, said Dr. Jim King, a Tennessee physician and the president of the American Academy of Family Physicians.
• Other issues: medical billing is “more complex than the IRS tax code,” there’s no methodology for reporting prices and there are questions about how insurance negotiations will work if pricing is available publicly, according to a report from the Deloitte Center for Health Solutions.
Issues for patients
• Americans who have health insurance don’t need to worry about a doctor’s fee schedule, King said.
• Consumers paying out of pocket shouldn’t automatically go to the doctor posting the lowest prices, King said. They should first ask providers if they offer discounts for self-pay patients. That way, the decision can stem from the quality of the practice and the patients’ comfort with the doctor and not just the cost.