By Susan Belknapp, California Business Journal
Can you imagine ever purchasing a car, home, or even a coffee maker without having a clue what it costs? Most consumers would never dream of making a major purchase without having some insight into price. Usually, the price is one of the first things a shopper sees and it wouldn’t occur to most people to commit to buying anything without having at least a ballpark idea of what they’re spending.
Once we are aware of the basics, we can make informed decisions, factoring in our personal priorities for luxury or economy and how much we are willing to spend on higher-end variables. There is one industry, however, that is one of the costliest for individuals and the United States economy and we not only have no choice on what we spend, the cost is deliberately kept from us. That industry is healthcare.
All under wraps
“There is zero price transparency in healthcare,” says Dr. Gail Tasch, co-founder of Medifees.com (MediVerity Inc), a web site she created with healthcare tech innovator Hugo Gallegos for price and quality comparisons on medical procedures and treatments. “If you call a clinic or hospital and ask, ‘I want to have this procedure, can you tell me about how much it will cost?’ They won’t tell you. But you’ll get the bill. I’m a physician and cannot find out the room rate for a night in my own hospital and I work here.”
After a few different personal experiences with urgent care and her daughter needing regular labs, Tasch decided she wanted to comparison shop for basic services and realized she couldn’t. Medicare and Medicaid give ranges for services covered but it can vary dramatically by region and it’s difficult for consumers to access or understand the information.
“As a physician, I think it’s very important for people to know what they’re committing to pay,” she says. “If you’re buying anything, whether it’s a shirt or shoes or a new car or appliance, you start shopping to find out what people are charging and then you make your decision. With healthcare, you can’t do that. Some cosmetic surgery or elective procedures will tell you how much they’re charging but not many. I’ve gone to one urgent care facility and paid $75 and gone to another and paid $900 — for the same issue.”
“It’s all secret,” she says. “Until you get the bill.”
A niche is discovered
Once Tasch recognized the need, she called Gallegos, who had gone through similar experiences and he immediately recognized the need too. Together, they began the long process of attempting to determine not only how the system worked but downloading a free Medicare data set to be able to create a user-friendly way to access and understand it.
They began researching the history of healthcare pricing and how it’s been monitored and divulged to consumers. Gallegos began designing the algorithms while they sought to purchase the data, another elusive step.
“There are other services available out there but they don’t have the critical data,” Gallegos says. “You can put in your zip code and it will give you a price quote but it doesn’t help you. There needs to be a site where you can say, ‘I need to go to a doctor visit for shingles.’ One might charge $125 for a 15-minute visit and one might charge $350 for the same. Deductibles are going up. They used to be $250, $500 and $1,000 but now they are $5,000 and even $6,000. Those fees are coming out of pocket until the deductible is met. Knowing the price is a big deal to people with high deductibles.”
Insurance adds to issue
One might think the insurance companies covering the procedures would provide checks and balances on the system but that isn’t the case at all. Tasch cites a New York Times article she found early in their research about secret deals that exist between health plans and hospitals and these deals are again, part of the problem. Insurance companies have different deals in different markets.
“Our goal is to have the ‘rack rate,’ the base rate they charge, private insurance charges, and what Medicare/Medicaid would pay,” Tasch says. “There are so many different fees for each situation. Medicare/Medicaid are published now but it is difficult to find exactly what you need, there are so many ways hospitals get around the low reimbursement.”
Tasch and Gallegos say that price transparency alone doesn’t mean much without an objective method for tracking quality. To this end, they acquired MediSkore.com, which is a physician-referral platform powered by a patent-pending scoring metric algorithm system that scores practitioners.
MediSkore is not just another arbitrary Google or Yelp feedback rating, but more of a FICO for practitioners. Doctors are scored from the moment they get their medical degree.
“Doctors are scored on a wide variety of factors, including training, education, publication, malpractice judgments,” Gallegos says. “Every one of these fields are given a negative or positive. Though we compare it to a FICO, it’s much more complex, but highly advanced system for compiling data on practitioners that begins as soon as they graduate medical school.”
Other physicians can refer based on the score so it will be used as a physician referral network. If a GP needs to refer a patient to an orthopedic surgeon, for example, that specialization can vary widely because there are so many procedures an orthopedic surgeon might perform. If they need one who ranks high for hand surgery, for instance, they can find one immediately.
The priority to getting to the next stages is purchasing the data. Tasch and Gallegos have a crowdfunding campaign scheduled to be launched in the fourth quarter of 2018. They intend to scale from Medifees’ minimal valuable product (MVP) using Medicare data to developing a healthcare price- and quality-transparency tool box by aggregating payer claims data and implementing our proprietary scoring metric technology — unless acquired A-round financing is required in the foreseeable future.
One of the great values that these initial steps are likely to drive is the snowball effect toward industry-wide transparency. Once the veil is lifted from one segment, others will be pressured to do same in order to compete. Like the technological evolution that healthcare was slow to adapt to but has now finally embraced, price transparency will come with pioneers like Tasch and Gallegos at the forefront of this movement.
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