Tips to Cut Your Health Care Costs

I recently had an experience that opened my eyes to the healthcare system. I have been fortunate to have good insurance coverage for the last 30 years. I am like many others, when the cost of care doesn’t impact my pocketbook; I am not a wise a consumer as I should be.

We recently have had changes in our insurance coverage, as many of you have experienced too. We have had some hefty out-of-pocket costs that has set me on a journey to be a wiser consumer.

I found a report by Kiplinger “50 Ways to Cut Your Health Care Costs.” I will share a few of the tips here. I have added it as a link on the website under resources. You may explore it further. I will hit the high points. Some you will know and others I hope you will find new and useful.

Stay in Your Network

Insurers have negotiated pricing with providers. You see those prices with providers in the network. You may also have a higher co-pay or co-insurance for providers out of the network, and also a higher deductible and a higher annual limit.

Save at Stand-Alone Radiology Centers

The average outpatient hospital cost for MRI and CAT scans is $1,384 to $1,668. But the average radiology center costs $445 to $725. (Information from Cigna) There can be a huge range between the highest and lowest costs in your area. [Most insurers have tools to help you compare the costs of x-rays and tests at different types of facilities in your area.] Check your insurer’s website.

Ask Your Doctor about Cheaper Facilities

Most doctors have privileges at several hospitals or outpatient surgery centers. The doctor’s costs will be the same. However, the facility fees can vary by thousands of dollars. This was an “A-Ha moment” for me. I learned after the fact, the doctor’s clinic would cost 1/3 the fees as the hospital. I think that is one reason why so many of these clinics and surgery centers are sprouting up.

Avoid the Emergency Room if You Can

You may not always be able to avoid an emergency care visit. However, you may be able to go to a much less expensive urgent care center or convenience care clinic. Cigna suggests using these facilities for minor cuts, burns, sprains, joint or lower back pains, and urinary infections. The average cost nationwide for an emergency room visit is $1,553 compared with $135 for an urgent care center and $58 for a convenience care clinic.

Determine ahead of time, who is in your network. You don’t want to be fumbling around when you have an emergency.

Sometimes you can’t avoid a trip to the emergency room, but you can still manage the costs as best as you can. You may be in the ER, but you are still the consumer. The triage protocols have employees following certain procedures. You need to be vocal about what you believe is needed.

I had something stuck in my esophagus. I called my doctor’s office to ask for assistance. I was told I needed to have my esophagus scoped; go to the ER. Because I presented with heart burn, – after all I had something stuck for hours in my throat – they followed procedures and were going to do an EKG. I was vocal and refused the procedure. Next they wanted to do some blood work. I also put a hold on that procedure. I did finally receive the services I came for and a bill of $4,500. I can’t imagine the cost if I had let them proceed unfettered.

Sign Up For Special Health Programs

You may get extra cash or discounts on your premiums for taking a health risk assessment or participating in a tobacco-cessation program. Employers are moving towards motivating employees to be healthier. Kaiser Family Foundation surveyed employers and found more than half offer special disease management programs others may provide a work-out room within their building or pay a set amount towards a gym membership.

A healthy employee is an asset to an employer. They miss fewer days and can be more productive on the job. Costs of insurance are determined by claims. Individuals behavior can make a difference in some health costs. Employers are trying to incentivize them.

Understanding and Defining the Most Effective Health Care KPIs

Although many people mistakenly believe that strategy evaluation systems are used only in manufacturing industries, they can also be effectively applied in non-profit spheres, like education and health care. In fact, the Balanced Scorecard (one of the most popular strategy evaluation frameworks) can be used in any sphere implying setting and achieving goals. For instance, the highest hospital accrediting institutions, such as Joint Commission International (JCI), issue nationwide and international patient safety goals in addition to fundamental measure sets. Bearing these goals and recommendations in mind is the recipe for designing effective Scorecard with winning indicators for health care domain. In this article we would like to share some tips on selecting the proper KPIs for health care institutions.

Step 1: Learn the JCI Patient Safety Goals

Because designing strategy evaluation framework begins with setting goals, it is important to learn the current nationwide and international patient safety goals issued by the Joint Commission or another accrediting body. These goals are annually updated. All healthcare organizations, both private and public stick to these recommendations. Once you have the list of adopted goals and supporting core measure sets, you can start identifying which core sets are applicable for your particular medical institution.

Step 2: Identify Sets Applicable For Your Health Care Unit

The Joint Commission International publishes ‘general’ measure sets which should be selected and adjusted according to the health care unit specialization. Here are some of the general sets offered by the JCI:

  • Acute Myocardial Infarction Core Measure Set (CMS).
  • Surgical Care CMS.
  • Perinatal CMS.
  • Pregnancy CMS.
  • Outpatient Department CMS.
  • STK (Stroke) CMS.
  • VTE (Venous Thromboembolism) CMS.

These sets include both clinical and non-clinical goals.

Step 3: Define Clinical and Non-Clinical Indicators for Your Particular Health Care Unit

Once you have the goals and core measure sets you can start selecting key performance indicators. To help you get started with your framework, we have gathered some of the most common metrics used in health care sphere. These include:

  1. Clinical Outcomes. This measure should reflect the outcome statistics compared with established norms. For instance, of 1000 patients admitted with heart attack, X amount of people get better within a week, Y amount of people stay hospitalized for more than a week, and Z amount depart.
  2. Number of People in Emergency Room. This metrics should reflect the quality of your ER service.
  3. ER Waiting Time + Severity of the Condition. This metrics is calculated like this: check-in time – admittance time / X days.
  4. Lab Results Waiting Times. This KPI shows how much it takes to get test results. First, you need to establish norms for your lab turnaround, and then compare those with the actual data. It is also advisable to divide tests into different categories (some tests are time-taking, while others can be done in a matter of minutes).

In addition to the aforementioned indicators, your dashboard may include other, more specific measures, such as average length of stay, hospital bed occupancy, rates of hospital acquired infections, patient satisfaction, and many other.