(The author is a Reuters contributor. The opinions expressed
are his own.)
By Mitch Lipka
BOSTON, April 25 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
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
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
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 (fairhealthconsumer.org) and
Health Care Bluebook (www.healthcarebluebook.com) 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
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
Another way to help filter doctors is to find one who is
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 CertificationMatters.org, run by the American Board of
Is passing the boards a guarantee that someone will be a
better doctor? No, says Carome, but it can be a reasonable
THE OLD-FASHIONED WAY
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
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)