Price Transparency in Boston

In a time when tightening belts and pinching pennies has become especially important, patients too often pay exorbitant amounts—enough to bankrupt two million American families a year—on medical care they may not even need.   

Patients will spend hundreds of dollars on a medication they are prescribed, even when a generic version is available that contains the exact same stuff and is 90% cheaper. Patients might pay thousands of dollars for an MRI, even when its results are unlikely to be informative. According to the Congression Budget Office, tests and treatments that do not improve health outcomes add up to an impressive total: $700 billion each year, the same amount we have spent on the entire Iraq War.

One of the reasons for this is painfully simple. Information on the prices patients face is rarely available to doctors when they are deciding which tests and treatments will go on the bill. A 2003 American Medical Association study showed that fewer than one in five doctors understands how much their patients pay for care.

In Boston, we are piloting a project called Costs of Care, that will harness information technology to give doctors information on the prices their patients face at the critical moment when medical decisions are being made.  

We believe that doctors who are cost-aware will be less likely to inflate medical bills unnecessarily. You can support our efforts by becoming a fan on facebook or by following us on twitter.

Timeout? No thanks. With stakes this high, I’d rather keep working.

As a medical student who is both only weeks away from graduation (Duke, please don’t withhold my diploma) and a long-time admirer of Dr. Groopman’s work, it is with some trepidation that I respond to the recent opinion piece in the Wall Street Journal “Why ‘Quality’ Care Is Dangerous” by Jerome Groopman and Pamela Hartzband.

However, the issue of healthcare quality improvement is too important for me to ignore such a potentially damaging editorial. Strangely, the article reminded me of a variety of clichés often used to argue against well-intentioned words of caution (such as those of Groopman and Hartzband) including, “Don’t throw the baby out with the bathwater;” “Don’t let the perfect be the enemy of the good,” and “Rome wasn’t built in a day.”

These clichés aren’t excuses. Progress has got to start somewhere, and while we have a long way to go, patients are far better off today than they were in November of 1999 thanks to the myriad efforts of so many dedicated quality improvement champions. Unfortunately, Groopman and Hartzband give only a brief nod to this progress.

By largely ignoring the successes and claiming that early missteps in particular quality efforts (namely public reporting and pay-for-performance) are examples of the system gone awry, the authors are doing patients and medical progress a serious disservice. They call for a “time out” in the progression of our healthcare system towards increased accountability and improved quality. (And let’s ignore for a moment the potential harm caused by the title of the article which implies that the entire spectrum of quality improvement efforts is dangerous).

Are there problems? Yes. Are there inherent risks in any major changes to a system as complex as the U.S. healthcare system? Of course. In fact, the article articulates many of the risks and, to date, failures of some of these efforts (which I hope to discuss in more detail in a follow-up posting). However, those of us who are patients, have friends or family who are patients, take care of patients, or simply pay taxes, should not accept the “time out” called for by Groopman and Hartzband; especially since I don’t remember seeing any breaks or timeouts in continuous quality improvement cycles.

- Duke University Medical Student, c/o 2009