The Rx: Better Data
For now, says Sibson’s Cyboran, most companies are too consumed with wrapping their heads around the immediate impact of health-care reform to deal with analyzing various performance metrics and the relative costs of hospitals near and far. The undertaking is not easy, many note, since most data is only available at the hospital level, with information on the performance of specific doctors lacking.
But over time, he and others hope that the combination of rising costs, reform, and private initiatives like Leapfrog will yield better data upon which both employers and employees can make their own decisions about care — and how much they’re paying for it. The Patient Protection and Affordable Care Act, in fact, specifically calls for both hospitals and physicians to report more about the outcomes of their work to the government, most of which will be made public. Hospitals will be eligible for bonus payments for outperforming on particular procedures or metrics, along with some penalties for issues like excessive readmission rates.
“We try to provide employees with tools to select the best hospitals for elective procedures, and give them quality ratings as well as price,” says Delia Vetter, senior director of benefits for EMC, which is a member of Leapfrog but so far does not give incentives to employees to use any particular hospitals for their surgeries. “I’m not sure [the effort] dramatically affects choices right now, but it at least prompts people to start thinking along those lines.”
Alix Stuart is senior editor for human capital and careers at CFO.
When the Prognosis May Call for Travel
The following high-cost procedures ($20,000+ in the United States) may be of most interest to companies contemplating the “medical tourism” option, since these surgeries may cost 70% to 90% less in other countries than in the United States.
• Heart bypass
• Heart-valve replacement
• Hip replacement
• Knee replacement
A larger number of lower-cost procedures, listed below, may still cost thousands of dollars less, even after travel costs are factored in. To date, however, employers have not warmed up to medical tourism in large numbers, and at companies that do offer it employees have been slow to participate.
• Knee surgery
• Shoulder angioplasty
• Transurethral prostate resection
• Tubal ligation
• Hernia repair
• Skin-lesion excision
• Adult tonsillectomy
• Cataract extraction
• Varicose-vein surgery
• Glaucoma procedures
Source: Sibson Consulting