BCBS of North Carolina's new price tool could make a difference for spine — 5 things to know

Practice Management

The Blue Cross Blue Shield of North Carolina was among the first to roll out a policy against covering spinal fusion for patients with just degenerative disc disease, according to a report in The State. Now the company has a new tool that could shake up the industry, and spine care is smack-dab in the middle of it all.

The new tool makes cost information available. Daniel Murrey, MD, a spine surgeon and CEO of OrthoCarolina, was quoted in the article praising BCBSNC for their transparency efforts, but also recognized it could be misleading.

 

For example, hospital bills are more expensive than outpatient surgery center bills, even when the same surgeons are performing the procedures. The new tool lists prices tied to reimbursement rates the company negotiated with individual providers instead of reporting averages.

 

Here are a few key issues with the tool:

 

• Huge price variation becomes evident
• Cost differential between hospitals, surgery centers and doctors offices are highlighted
• The numbers don't take patient risk factors into account
• The procedures include bundled fees, such as anesthesia, medication and facility fees, which are attached to the surgeon's name
• Some high-priced providers are asking for reductions on insurance payments because the list is made public

 

Dr. Murrey also mentioned the publicly-available price information shows how much patients can save in the outpatient setting. The site has been live for three weeks and reports 8,000 unique visitors as well as 18,000 prices searches.

 

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