Medicare: How to lower your surgery costs

Imagine going to the grocery store, picking up the items you need for
the week, but not knowing how much anything costs until the store sends
you a bill two weeks later.

Sadly, that’s how our health care system works every day.

Health care costs now represent one in every $5 spent in our country. Patients’ deductibles and co-pays are rising. Prescription drugs are often unaffordable for many Americans.

We must do something about rising costs, and one key is to empower
patients with the information they need to drive costs down and quality
up by making the health care system compete for their business.

That’s why Medicare recently launched a new online tool that allows
consumers to compare Medicare payments and patient copayments for
certain surgical procedures that are performed in both hospital
outpatient departments and ambulatory surgical centers.

The Procedure Price Lookup tool
( displays national averages
for the amount Medicare pays the hospital or ambulatory surgical center.
It also shows the national average co-payment amount a beneficiary with
no Medicare supplemental insurance would pay the provider.

Working with their doctors, people with Medicare can use the
Procedure Price Lookup to consider potential cost differences when
choosing among safe and clinically appropriate settings to get the care
that best meets their needs. And cost differences can be substantial.

lookup tool is needed because the law requires Medicare to maintain
separate payment systems for different types of health care providers.
That means Medicare pays sharply different amounts for the same service,
depending on the locale of the care. It also means that people with
Medicare pay different co-pays for the same service, depending on where
it’s delivered.

Unfortunately, this is a prime example of Medicare’s misaligned
financial incentives, under which providers can make more money if they
treat patients at one location as opposed to another. Here’s an example:
a Medicare beneficiary needs knee surgery, and her surgeon offers her
the choice to have the surgery in the local hospital’s outpatient
department or at an independent surgery center.

With the Procedure Price Lookup tool, the beneficiary can type in the
type of surgery and see an estimate of the difference in out-of-pocket
costs between the two settings.

It would take an act of Congress to change Medicare’s payment
systems. In the meantime, patients have the right to at least know what
they will be charged. The Procedure Price Lookup makes that information
easy to access.

Procedure Price Lookup is part of our eMedicare initiative and joins
other patient-oriented transparency tools, including an overhauled
version of our drug pricing and spending dashboards. These new tools
provide patients with Medicare and Medicaid spending information for
thousands more drugs than ever before and, for the first time, list the
prescription drug manufacturers that were responsible for price

We launched the eMedicare initiative to empower beneficiaries with cost and quality information. eMedicare also offers a mobile-optimized out-of-pocket cost calculator to provide beneficiaries with information on overall health plan costs and prescription drug costs.

The case for price transparency throughout the health care system is clear. The need for consumers to comparison-shop is growing as high-deductible plans become the norm. We also need to integrate quality information with price transparency, so consumers are empowered to seek out high-value care among providers competing on both cost and quality.


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