Palm Beach Brain and Spine

It’s been 15 years since Harvard professor Regina Herzlinger coined the phrase “consumer-driven health care” and, in the time sense, everyone from right to left on the political spectrum – from Newt Gingrich to Nancy Pelosi – has been promising us tools for comparison shopping health care in the same way we do for homes, automobiles, and groceries.

What tools have we got so far to compare the cost and quality of medical providers?

One resource for comparing costs of medical services and procedures is FAIR Health’s “Consumer Cost Lookup” website at www.fairhealthconsumer.org

As the above illustrates, part of using this application requires knowing the “CPT code” for a medical service or procedure.  What’s a CPT code?   

CPTs are five-digit codes developed by the American Medical Association as short-hand for long descriptions of services and procedures.  CPT code 99203, for example, is an “Office or other outpatient visit for the evaluation and management of a new patient.”

Ask your doctor which CPT code(s) he or she expects to bill for your service or procedure. 

CPT code 22523, for purposes of the example below, is “Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic.”

This is a minimally invasive procedure for repairing fractures in spinal vertebrae. 

Consumer Cost Lookup shows the average charge in a community. 
 

Ask your surgeon how much he or she typically charges for your service or procedure, then compare that with FAIR Health data.

When considering surgery, bear in mind that you’ll want to research not just surgeons but facilities (hospitals or ambulatory surgery centers) and anesthesiologists as well.

At present, FAIR Health’s Consumer Cost Lookup offers little information on anesthesiology – and none at all regarding facilities. 

That said, some federal and state agencies offer cost information about hospitals and surgery centers.  The Agency for Health Care Administration (AHCA) in Florida, for example, reproduces facility cost and utilization data at
www.floridahealthfinder.gov/CompareCare/SelectChoice.aspx  

Similarly, the national Center for Medicare & Medicaid Services (CMS) at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html