You don’t have to travel far to get fairly-priced health care for many tests and procedures.

The latest QualityCounts® report from The Alliance shows that members could have saved $7.8 million if outpatient procedures covered through our network had been performed at the lowest cost provider within 30 miles of the patient’s home.

The 2013 QualityCounts Outpatient Procedures and Tests Report offers cost information on 20 outpatient surgeries and tests performed at 71 facilities in The Alliance network. The report has been expanded to offer cost information for Illinois health care providers in Stephenson and Winnebago Counties.

Use QualityCounts to compare costsDollar sign inside a stethoscope

The prices revealed by the report show the potential for savings for both employees and employers. It’s also an opportunity to educate employees about how variation in health care prices hits their wallet.

Consider the example of an employee who needs cataract surgery, has a $300 deductible and pays 20% of covered health care costs, while the employer pays 80%.

The QualityCounts report revealed that the median price of cataract surgery ranged from $3,554 to $9,201 among providers within The Alliance network. That means the employee’s potential out-of-pocket cost ranged from $2,140 at the highest-cost provider to $1,011 at the lowest-cost provider.

The median price charged by health care providers also varied widely for other procedures:

  • Adenoidectomy and Tonsillectomy median prices ranged from $3,025 to $8,536.
  • Colonoscopy with Biopsy median prices ranged from $1,284 to $6,861.
  • Thorax CT with Contrast median prices ranged from $551 to $3,413.

The QualityCounts report offers median prices as well as the range of high and low prices paid to each provider to offer a fair estimate of what the provider’s charges are likely to be. The median shows the middle point; half of charges were more than this amount and half were less than this amount.

Understand your share of the costs

It’s important to note that while employees are typically responsible only for a portion of the price charged by the facility, it is likely that the employee’s portion of the costs will be greater at more expensive facilities. In other words, if you pick a facility that costs more, you will usually pay more.

This message is likely to hit home as more employees are asked to pay a greater share of the costs through high-deductible plans and other measures.

Paul Meyer

Paul Meyer

Chief Operating Officer at The Alliance
Paul Meyer joined The Alliance in 1996 and served as the director of finance and operations until he became chief operating officer in 2007. As the COO of The Alliance, his main duties include overseeing the claims and customer service, finance, MIS, and HR departments as well as business planning and reporting. Meyer also serves as the treasurer of The Alliance Board of Directors.

In addition to his work at The Alliance, Meyer serves as board chair for National CooperativeRx / WisconsinRx, providing direction for this not-for-profit prescription drug purchasing cooperative. Meyer also serves on a number of other boards, including the Wisconsin Statewide Health Information Network (WISHIN), Catholic Charities of Madison, and All Saints Neighborhood.

Read blog posts by Paul.
Paul Meyer

Pin It on Pinterest