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Craigslist became a household name byconnecting buyers and sellers of diverseitems and services. HealthyPrice, Inc.hopes to do the same for doctors and

patients.The Burbank-based HealthyPrice has sofar enlisted about 100 physicians in the LosAngeles area. They have posted prices onthe HealthyPrice website for about 400different medical procedures.

The pricesrange fromabout $6 fora fastingglucose testto $4,950for theremoval of

kidney and bladder stones (anesthesiaservices included). Also included are priceybut commonplace preventive careprocedures, such as a colonoscopy($1,090, with anesthesia). The prices reflectan approximately 30% to 40% discount offwhat an uninsured patient would becharged.

Patients dont want to haggle withdoctors about prices and doctors dontwant to haggle with patients, said Philip I.Weintraub, M.D., a Burbank urologist whofounded HealthyPrice last year with

another local urologist, Michael J.Hyman, M.D.

Weintraub said the service is focusedprimarily on uninsured patients, although

those who are underinsured or who havelarge deductibles would likely use theservice as well.

California has a potentially hugemarket for such services: a recent reportby the UCLA Center for Health Policy

Research concluded that thenumber ofuninsuredstatewidehas soaredin the lastdecade from6 million to

8 million. Even Californians withcoverage often spend thousands ofdollars a yet on out-of-pocket expenses.

Hyman said part of the reason forsetting up HealthyPrice is that even savvypatients who have insurance can getovercharged and not even be aware of it.One example: his wife had to undergo anMRI exam during an emergency roomvisit. Despite being covered byinsurance, her bill came to more than

A Craigslist Moment For MedicineDozens of L.A.-Area Providers Post Prices On Line

California Edition

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Payers & Providers

$1,200. HealthyPrice offers MRIs startingat $575.

Patients who use HealthyPrice agree

online to the price for a procedure, pay itin advance, and set up an appointmentwith the physician. The patient receives apre-arranged billing code to bring to thephysician to verify the discount.HealthyPrice handles the payment, minusa billing fee, and pays the doctor viacheck or Paypal.

Thats the only paperwork the doctorspractice has to handle, Woodward noted,adding that his companys intent is to alsostreamline administrative work forphysician practices.

In addition to the agreements with the

physicians, Woodward said HealthyPricealso has an arrangement in place withWest Coast Clinical Laboratories toprovide discounted laboratory testing.Dozens of tests are available through theservice.

Woodward expects to have all of LosAngeles County the nations mostpopulous metropolitan area coveredwith participating physicians by the end ofthe year, with rollouts for the rest ofCalifornia and other states in the works.

HealthyPrice launched its servicesearlier in the spring, and has so far only

conducted about a dozen transactions,according to Woodward. But industryobservers say it has the potential foradding a desperately needed dose of pricetransparency to healthcare delivery.

Something like this is refreshing to thegeneral populace and physicians who

Page 2

have to deal with a third party and neverknow whether they will get a procedureor exam approved and paid for, said

Robert Bitonte, M.D., a rehabilitationspecialist who is president of the LosAngeles County Medical Association.

Despite Bitontes appreciation forHealthyPrice, he cautioned that somephysicians may be reluctant to post theirprices in such an open manner.

I can sense it is going to be a culturalshock, but on the other hand, it may savepatients and physicians a lot of time, hesaid. It also goes a long way to restoringthe patient-physician relationship. Theyare talking solely about the procedureand exam, and both know how they are

going to be treated economically.Bitonte also noted that patients using

HealthyPrice could still be potentiallyovercharged due to miscommunication.However, Woodward said that there aresafeguards in place to prevent that fromhappening.

Others believe such an open conceptcould jar other healthcare constituentsinto being more open.

Its a great idea, said WellsShoemaker, M.D., chief medical officerfor the California Association ofPhysician Groups. Id like to see it

applied to hospitals and health plans.They treat price data like industrysecrets, and it creates all sort ofcomplications in the provisioning forcare.

Top Placement...Bottomless Potential

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In Brief

CDPH Levies 10Administrative

Penalties Against 9Hospitals

The California Department of PublicHealth has issued 10 administrativepenalties against nine hospitals,including the third and fourth penaltyto Scripps Green Hospital in La Jolla.

Scripps was penalized $50,000 forallowing a physician with noexperience using an instrument for aspinal drain to insert the instrument,causing a portion of it to sheer off inthe patients body. It received anotherpenalty for $75,000 for failure to trainstaff about cleaning a particularsurgical instrument used in orthopedicprocedures. A surgeon discovered the

instrument had retained dried bloodwhile in the middle of a procedure. Asa result, 11 patients were exposed tobloodborne pathogens, according tothe CDPH.

Alameda County Medical Centerwas levied a penalty of $75,000 whenit gave an intravenous push dose ofDilantin to a patient that was meant tobe parceled out over a period of time.The patient died as a result.

Radys Childrens Hospital in SanDiego received a penalty of $50,000for administering a medicine to treatmuscle spasms at 17.9 times theprescribed dose. The medication fortopical and intravenous use was stored

in the same cabinet, leading to theerror.Parkview Community Hospital in

Riverside received a penalty of$50,000 when a physician withoutproper privileges removed the wrongkidney from a patient. The patient wasalso not properly informed about therisks of the procedure including thepotential for wrong-side surgery.

Both Hi-Desert Medical Center inJoshua Tree and Tri-City Medical

HealthyPrice (Continued from Page One)

Continued on Page 3

NEWS

Medical Groups Claim ProgressCAPG Survey Says Many Improve Patient Care

The California Association of PhysicianGroups reported in its annual Standards ofExcellence survey a marked improvementamong its membership in accommodatingpatient needs.

Eighty medical groups with 10.8 millionpatients statewide participated in the survey,which polled the participants on how theytake care of their patients, their usage ofhealth information technology and theiroverall transparency, among other criteria.

CAPG Chief Medical Officer Wells

Shoemaker, M.D., admitted that an essentiallyself-administered test could be the subject ofskepticism, but noted that its membership hasbeen responsive to the need for change.

There have been a lot of voices out thereasking us to improve, including consumeradvocacy groups becoming more vocal, andemployers who in this economy cannot affordto have their workers out for the entire day tosee their doctor, he said.

Respondents fill out a 19-page form. Amongthe criteria on which theyre scored:

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Page 3Payers & Providers

Longer ALOS!*

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*For our ads, not your hospital

NEWS

In Brief

Center in Oceanside receivedpenalties of $50,000 for failing tofollow surgical protocols that led topatient being burned during surgery. Itwas Tri-Citys second administrativepenalty.

Pomerado Hospital in Poway alsoreceived its second administrative

penalty when a patient fell from achair that did not have a proper alarmdevice attached. The penalty was$50,000.

The other hospitals receivingpenalties were Marin GeneralHospital in Greenbrae; and MissionHospital Regional Medical Center inMission Viejo.

L.A. County DHSForecasts Large Deficit

The Los Angeles County Departmentof Health Services projects a looming$204 million budget decit by the endof the current scal year. The shortfallis projected to reach nearly $600million in 2010-11.

DHS hopes to close that gap with aproposed hospital provider fee andsome federal supplementary funding.

Clearly this year almost everythingis focused on the hospital fee,' saidinterim DHS director John Schunhoff.We are concerned about that.''

Los Angeles County Supervisor ZevYaroslavsky proposed the DHS staffreturns in 30 days with a report onspecic steps they will take to close

the budget decit if the revenuestreams do not materialize.

"We are dependent on the state tonegotiate ... key initiatives. We are notat the table and not privy to criticalinformation ... that would make orbreak the county's health caresystem, Yaroslavsky said.

In past years of large budgetdecits, DHS has cut outpatientservices and outsourced other servicesto private-sector providers.

Expert Healthcare Communications

!White Papers !Media Campaigns !Newsletters

(818) 848-8510 www.rfsconsult.com

Southwest Enters Pact With CMSFunding Loss Delayed in Lieu of Improvements

Of the participating groups, 25, or about30%, received the highest scores of elite, upfrom 20 the prior year. Such a score

indicates a high competency in caremanagement practices, transparency,accommodating patients; and healthinformation technology. Elites includedBeaver Medical Group in the SanBernardino area; Coast HealthcareManagement in Orange and Los AngelesCounties; Healthcare Partners MedicalGroup in Torrance; and Kaisers PermanentMedical Groups in Northern and SouthernCalifornia.

Another 14 groups received scoresof exemplary high competency in threeof four areas.

Troubled Southwest Healthcare System hasreached an agreement with the CMS toresolve the problems at its hospitals inMurrieta and Wildomar in exchange forkeeping its funding for another year.

As part of the agreement, Southwest hasagreed to retain experts in emergencyservices; infection control; pharmacy/medication administration; equipmentmaintenance; leadership and accountability;and quality assessment/performanceimprovement.

Each expert will report to a leadconsultant, who will report the preliminaryndings directly to the Centers for Medicareand Medicaid Services over the next twomonths.

CMS will also conduct an extensivesurvey in the spring of 2011 to determine

whether Southwest has improved its patiencare enough to continue participation in thMedicare and Medicaid programs in the loterm.

CMS had announced it would suspend

Southwests participation in federalreimbursement programs on June 1 due toongoing quality-of-care problems dating to2007. Medicare and Medicaid reimbursemaccount for about 40% of Southwestsrevenue, according to data from the OfceStatewide Health Planning and Developme

The California Department of PublicHealth, which has levied six administrativepenalties against Southwest, has also moverevoke its operating license. Southwest iscontinuing negotiations with CDPH, but habeen unable to reach an agreement, ofciasaid.

If the medical group has a program totarget high-acuity patients (two or more

chronic conditions) If a disease management program is inplace and its specics

If its uses hospitalist physicians forinpatients

If hospital readmissions are analyzed

If the medical group has a plan to continuefunction during a major disaster or otherdisruption Whether or not it uses electronic medicalrecords If it participates in the IntegratedHealthcare Association pay-for-performanceprogram and shares data

CAPG (Continued from Page Two)

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8/9/2019 Payers & Providers Issue of May 20, 2010

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Payers & Providers Page

One of the fundamental challenges facingevery conscientious benefits administratoris keeping up with the massive amounts ofpaper and data accompanying thisfunction.

Coupling this issue with the rapidlychanging legislative landscape from theARRA, healthcare reform and othersources means that theadministration of benefitscontinues to become moreand more difficult.

The use of technology can

greatly improve the benefitsmanagement function.There are many

advantages of using anonline benefitsadministration system. Firstand foremost is having all ofyour benefits information inone database, enablingaccurate reporting, excellentcustomer service, soundfiscal management, andreduced paper handling.

Few organizations source all of

their benefits from a singleinsurance carrier, and gaining aninstant, holistic view of an overall benefitsprogram is almost impossible. Forexample, answering simple questions likeHow many management employees areenrolled in the PPO plan? is very difficultwithout an online tool.!

Providing good customer service isequally difficult. Simply answering anemployee's questions when they calltypically requires the search for a paperfile and digging through stacks of forms.Employees should be able to go online

and see what benefits they are eligible for,detailed comparisons of plan benefits andcosts, what benefits they are currentlycovered under, and which of theirdependents are covered. During openenrollment, they should be able to makechanges without having to receive, fill outand return stacks of paperwork.!

In todays online world, most employeesare banking, shopping, reviewingchildrens schoolwork and performing amyriad of other activities online. Instead

of resistance to online business functionsthere is actually an expectation that thesefunctions should occur there.!

Another challenge is reconciling thecarrier bills.! A well-designed benefitsadministration system should eliminate thmonthly headache or at the very leastminimize the effort expended. In an ideal

situation, benefits administratwill be able to self-bill senda system generated invoice thmatches the data the systemregularly transmits to the carr

thus eliminating any need toreconcile bills.!High-quality benefitsadministration systems will aenforce eligibility rules,preventing the accidentalcoverage of an employee in aplan or during a period whenthey should not be covered. addition, these systems enforthe completeness and accura

data collection.!. Most of todays online systems, likeKeenans BenefitBridge, do not requi

involvement since they run as hostedsolutions with no infrastructureinvestment required to support them.! Thehave proven to be very effective for a widrange of organizations.! For example, theKeenan BenefitBridge has been in place fofive years and is linked up with the fivelargest California health plans.! It currentlyserves some 200,000 members representi200 different employers with groups rangfrom 100 to 20,000 members.!

The best time of the year to install onthese systems is immediately following thanniversary date of benefit plans, taking

advantage of periods of time when there less activity.! Dont miss the next opportuto automate these critical functions.

OPINION

Cleaning Up The Administrative MesNew Applications Can Make Streamlining a Realit

By

Henry

Loubet

Henry Loubet is Chief Strategy Officer for

Keenan & Associates. He is a member of

Payers & Providers Editorial Baord.

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

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