Andrew Garland: Keeping A Keen Eye on Cost of Care

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This commentary is by Andrew Garland, Vice President of Client Relations and External Affairs regarding how Vermonters can collectively impact the future costs of health care premiums.

Health care costs are rising far faster than incomes, but there is something every Vermonter can do about it. Individually, we can make decisions that result in a significant collective impact on the future cost of premiums. By looking at price comparisons before we make our health care appointments and by choosing the lowest cost, highest quality provider, each one of us is making a choice that will result in future premium savings. 

I look at price comparisons in advance when my family is able to plan for a health care procedure. If I choose a provider a little further down the road, I can often be seen sooner and the price can be dramatically lower. Health care is expensive, and a little research can make a big difference. When I make informed choices about where to receive care, I can actually make an impact on the overall cost of care for all Vermonters. In fact, these small efforts can slow the rise of premiums and send a message to providers that I won't pay exorbitant prices. 

The price transparency tool on the Blue Cross and Blue Shield of Vermont website is an easy way to comparison shop. The tool will show you that a preventive mammogram screening can cost between $370 to $900 within a 50-mile radius of Central Vermont. Some of our local facilities are small, making them easily accessible with shorter wait times, free parking, and speedy registration, getting you out of the waiting room and in to see your provider in remarkable time.

We are lucky to live in a small state with high-quality hospitals and independent providers. For some of the more typical scheduled medical visits—such as mammograms, knee or hip replacements, colonoscopies, blood tests, or x-rays, some quick research can provide eye popping differences in price, and usually there is more than one option within an hour drive. Even if your health insurance plan covers these visits with the same out of pocket costs to you, you will be paying the difference in the price of premiums in future years.

X-rays are another example where you can save real dollars in premium increases. A chest x-ray in one Vermont emergency room is $2,392, which is 62 times more expensive than in a doctor’s office (which rings in at $38 at one local practice near me). If you are able to see your primary care provider in the office, you know you will have more coordinated care, better follow up, and it will be significantly less expensive.

A blood panel at an independent lab typically costs $36, whereas at a hospital the same service costs ten times more, ringing in at $331 at one Vermont hospital. What is interesting is that there is no difference in the quality or accuracy of these labs—the tests are the same, they simply have wildly different price tags. Ask for a price before your provider sends your blood to the lab.

A colonoscopy with a biopsy is another service with wide price variations. At one independent provider it costs $2,279. At a hospital in the next town over the same procedure costs $13,208. An alternative preventative screening for people over 40 with average risk and no family history of colorectal cancer is a fecal immunochemical test (FIT). The FIT tests are less invasive than an outpatient colonoscopy procedure, it can be done at home every 1-2 years, and costs around $75 per test.

When patients start choosing the lowest cost, high quality hospital or provider, they are essentially voting with their feet and sending a clear message that they reject services with inflated price tags. All too often, we assume that the only option for minor surgical procedures is the one that is at the hospital that your primary care provider is affiliated with—and where providers are likely to refer us first. Ask for a cost estimate before you make the appointment.

We have a complex relationship with health care in Vermont. We value convenient access to the best care available but struggle with affordability. Premiums increase in tandem with escalating hospital and drug prices to pay for the higher cost of care. These increases leave Vermonters frustrated with the system in place and advocating for significant reform.

Collectively Vermonters spent an astonishing $7.95 billion on health care in 2020. That’s over $12,600 per person living in our state, even though many Vermonters receive no care at all while other individuals require care that costs hundreds of thousands—and even millions—of dollars per year.

These are challenging and multi-faceted issues that are not easy to resolve, but individually there are steps we can take to make health care less expensive for all Vermonters.