YOUR MONEY-Look beyond Medicare data when shopping for healthcare


(The author is a Reuters contributor. The opinions expressed are his own.)

By Mitch Lipka

BOSTON, April 25 (Reuters) - The recent release of Medicare billing records for doctors across the United States brought hope that consumers would get what they need to comparison-shop for healthcare.

Although that did not turn out to be true, you do have other places to look.

Experts say there are limits to how much can be learned from data tracking 880,000 doctors billing about $77 billion to the federal healthcare program for the elderly for some 6,000 types of procedures.

How Medicare billing works is just one of the issues that could foul up anyone hoping to examine the new data. That is because in a group practice or a larger clinic, a single doctor's name could appear for certain procedures when many other physicians are doing the work.

"There's a low likelihood that anyone will find it useful, given the context and the raw nature of the data," says Dr. Michael Carome, director of the consumer advocacy organization Public Citizen Health Research Group.

But there are other ways to track prices, physicians and the quality of care you are receiving. Here is a look at what is available:


Many health insurance companies have become good sources of information, says Laura Etherton, healthcare policy analyst for the consumer-focused lobbying group U.S. PIRG. Policy holders usually can get a ballpark estimate for the cost of anything from a colonoscopy to a tonsillectomy.

Some insurers include pricing data and information about whether a practice has met certain quality benchmarks.

An Aetna customer in New York City, for example, can learn that under her insurance plan, she would have to pay $802 to $992 for a colonoscopy, $22 to $125 for an ankle x-ray, and $44 to $69 for a routine blood screening that includes a complete blood count. UnitedHealthcare also offers an estimator tool that allows its customers to create scenarios, such as if they are going to have knee surgery, to get an idea of total costs and out-of-pocket expenses they could face.

Some insurers, such as Kaiser Permanente and Harvard Pilgrim, publish lists of what they have paid providers for a wide range of medical charges. While there are innumerable variations of what different policies cover, seeing those estimates gives consumers an idea of the kind of charges they could face after receiving care.


For those whose insurers do not drill down to the specifics of policy coverage or even have estimators, the non-profit organizations FAIR Health ( and Health Care Bluebook ( give consumers a window into medical pricing.

The National Committee for Quality Assurance and local versions like Oregon's Partner for Quality Care also provide a way to screen practitioners who can be filtered by measures including how often they conduct certain basic screenings, whether they prescribe generics for various conditions, and their use of diagnostic tests. Consumers can also find ratings of insurance companies and medical facilities through these quality-measurement groups.


Carome, a licensed physician in Virginia, recommends consumers start with their state medical board to learn what they can about doctors. The amount of information varies by state, he says, but you should be able to find out if doctors are licensed. In addition, you can see if they have faced recent disciplinary action, had to pay out on malpractice lawsuits or were disciplined by a hospital.

Spotting a pattern of problems on a doctor's record can be a red flag, Carome says. "Certainly, a single lawsuit doesn't mean that physician is a poor practitioner," he notes.

On the flip side, it can take a lot to be disciplined by a state medical board, he says, and research by his organization has found hospitals to be lacking when it comes to reporting internal discipline.

Another way to help filter doctors is to find one who is board-certified.

Board certification for specific specialties, such as from the American Board of Internal Medicine, indicates that a practitioner passed difficult testing and has committed to continuing education, Carome says. Consumers can check the website, run by the American Board of Medical Specialties.

Is passing the boards a guarantee that someone will be a better doctor? No, says Carome, but it can be a reasonable tie-breaker.


Carome says relying on computers is not going to be nearly as beneficial in a search for relevant information about doctors or a facility as it is for someone shopping for a vacation or a television. Check out doctors and facilities by getting recommendations, asking questions of the practitioners and, before undergoing a procedure, getting a second opinion, he says.

Doctors do not necessarily agree on courses of treatment, Carome says. So if a surgery - whether it is replacing a heart valve or removing a gall bladder - is not an emergency, he says, it is worth asking another doctor for a second opinion.

(Editing by Lauren Young and Lisa Von Ahn)

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