The New York Times (10/28, A15, Pear, Subscription Publication) reports, “Administration officials rejoiced at the modest increase, which could pay political dividends to President Obama as he tries to win the votes of older Americans in his bid for re-election.” Furthermore, “officials said the smaller increase showed their prudent management of the program, using tools provided by the new health care law to control costs.” The Times quotes Jonathan D. Blum, deputy administrator of the federal Centers for Medicare and Medicaid Services, who “said officials were seeing ‘much lower utilization and spending growth’ in Medicare than they had expected.”

The Wall Street Journal (10/28, A6, Radnofsky, Subscription Publication) cites HHS Secretary Kathleen Sebelius, who said that retirees could see about $40 more each month because of a higher Social Security benefit coupled with the smaller Medicare premium increase. The AP (10/28, Alonso-Zaldivar) reports that according to Sebelius, it is “pretty remarkable” that the premiums will remain low. She remarked, “Thanks to the Affordable Care Act, Medicare is providing better benefits at lower cost.”

The Boston (MA) Globe (10/28, Kotz) “Daily Dose” blog reports that “Sebelius called the lower-than-expected premium increase ‘the latest round of good news’ and added that the projected increases in Medicare costs were lower than expected partly because of greater competition among health plan providers put in place by the Affordable Care Act.”

The Hill (10/28, Pecquet) reports in its “Healthwatch” blog, “CMS Administrator Donald Berwick said the lower-than-expected premiums hike was due to two principal factors: historically low healthcare utilization rates, due in part to the healthcare reform law’s investment in prevention and the 3.6 percent Social Security cost-of-living (COLA) hike announced earlier this month.” In a statement, Rep. Pete Stark (D-Calif.), said, “These reductions are a direct result of the Medicare reforms included in the Affordable Care Act ��� further affirmation of the positive impact health reform is already having on Americans’ pocketbooks.”

The Washington Times (10/28, Cunningham) quotes Berwick, who said, “We are excited about being able to offer people better Medicare at less cost. That just makes sense.”

The Washington Post (10/28, Kliff) reports, “The announcement was the third piece of good news about Medicare premiums this year.” AARP’s legislative policy director, David Lerner, remarked, “This small increase is welcome news.”

Also covering the story were the Baltimore Sun (10/28), Reuters (10/28, Selyukh), Bloomberg News (10/28, Eisenberg), CQ (10/28, Adams, Subscription Publication), and Modern Healthcare (10/28, Zigmond, Subscription Publication).

The Los Angeles Times (9/28, Stein) comments on the same survey in its “booster shots” blog, “Americans aren’t just cutting costs these days by clipping coupons — they’re also making some potentially dangerous choices about prescription drugs.” Among those: “16% don’t fill prescriptions, 13% have taken a drug that expired, 12% skipped a dose without checking in with the doctor or pharmacist, 8% cut pills in half and 4% shared their medicines.”

The New York Times (9/28, Carrns) similarly says in its “Bucks” blog, “Americans are spending less money out of their own pockets each month on prescription drugs, probably because of greater use of lower-cost generics,” yet many are still “cutting costs on pills in ways that are unsafe.” And “lower-income people, those without drug benefits and those with monthly drug costs of more than $50, were most likely to take such steps.”

WebMD (9/28, Mann) reports that “many people do not fill their prescriptions, take expired pills, skip doses, or split pills — all to lower costs.” Lisa Gill, the editor of prescription drugs for Consumer Reports, recommends that physicians “find out the costs of medications in advance.”

ABC World News (9/27, story 5, 0:30, Sawyer) reported, “The Kaiser survey finds that over the past ten years, health insurance premiums are up 113% while wages have increased only 34%.”

The CBS Evening News (9/27, story 2, 0:20, Pelley) reported, “While the value of homes has been falling, the cost of healthcare has been rising. A report on health insurance costs today says the average annual family premium is $15,073. That’s up 9% from last year. Employers generally pick up the majority of the costs.”

The New York Times (9/28, A1, Abelson, Bernstein, Subscription Publication) reports on its front page that the Kaiser survey results are “creating more uncertainty for the Obama administration and employers who are struggling to drive down an unrelenting rise in medical costs.” Partly that’s because “Kaiser estimates that one to two percentage points of the increase this year is related to provisions of the law already in effect,” and partly because, “many businesses cite the cost of coverage as a factor in their decision not to hire, and health insurance has become increasingly unaffordable for more Americans.”

The Washington Post (9/28, A1, Aizenman) reports on its front page that the Tuesday release of a Kaiser Family Foundation and Health Research & Educational Trust annual survey highlighted “premiums for employer-sponsored health insurance continued to escalate this year even as the share of workers getting less generous coverage reached a new high.” Drew Altman, president of the Kaiser foundation said, “Without any real national discussion or debate, there’s a quiet revolution going on in what we call health insurance in this country. Health insurance is becoming less and less comprehensive.” Though roughly half of Americans “are covered by an employer sponsored health plan,” yet “nearly 70 percent report being worried about having to pay more for healthcare or health insurance. Almost a third are ‘very worried.’”

McClatchy (9/28, Pugh) notes that Kaiser President Altman is uncertain if the sharp premium increases are temporary or part of a larger trend. “Karen Ignagni, the president of America’s Health Insurance Plans, said the increasing cost of medical care was the main culprit behind the rate increases.” Also “insurers may have set rates higher this year thinking that the Affordable Care Act would increase their costs.”

The Los Angeles Times (9/28, Helfand) reports, “The price of health insurance provided by employers for families jumped 9% this year over 2010 as rising healthcare expenses contributed to the largest premium increases in six years.” In response, “companies and workers are increasingly turning to high-deductible policies that require workers to pay more out of their pockets for medical care.”

The Wall Street Journal (9/28, Mathews, Subscription Publication) says that with many employers and employees turning to higher deductible plans, the sharp growth in premium prices seems counter-intuitive, though other industry experts emphasize that the remaining pool of candidates tends to be older and more likely to draw on the insurance.

USA Today (9/28, Kennedy) reports, “As Congress works to decrease the federal deficit by cutting health care programs such as Medicare, policy experts say health providers will have to find money elsewhere, which could force insurance premiums higher for most Americans.”

Bloomberg News (9/28, Young) reports, “The average cost of a family policy climbed 9 percent in 2011 to $15,073, according to” the Kaiser Foundation’s “poll of 2,088 private companies and state and local government agencies.” It also found that “the average price of a family plan has risen 113 percent since 2001.” White House Deputy Chief of Staff Nancy-Ann DeParle’s blog posting is cited saying that “premium increases aren’t the result of the health overhaul,” but instead are due partly to “insurers [having] overestimated the new law’s effect and the gain in health-care spending this year.”

The Financial Times (9/28, Rappeport, Subscription Publication) says that the increase undercuts the Administration’s argument that its healthcare reform would cut costs.

Reuters (9/28, Selyukh) reports that Altman said, “There are a variety of factors that could have been responsible for (premium increases), but the major reason is not the healthcare reform.”

Modern Healthcare (9/28, Daly, Subscription Publication) reports, “The only factor among many possible drivers to the latest premium increase that the survey authors were able to quantify were two provisions of the Patient Protection and Affordable Care Act that went into effect last year: a requirement for plans to offer coverage to the young adult offspring of their enrollees and mandated coverage of preventive care. Those provisions composed up to 2 percentage points of the 9% increase, the authors found in a separate analysis.”

The National Journal /Kaiser Health News (9/28, Appley, Subscription Publication) reports premiums have grown by “triple the growth seen in 2010.” And “the White House quickly weighed in, accusing private health insurance companies of reaping profits based on forecasts of rising costs that didn’t turn out to be accurate.” While, “many factors drive premium growth, the main one [is] actual spending on medical care.”

Politico (9/28, Feder) reports, “Premiums for employer-provided health insurance jumped 8-9 percent in 2011, passing $15,000 for family coverage – which is more than the cost of a Ford Fiesta.” More coverage appears in AFP (9/28), The Hill (9/28, Pecquet, Baker) “Healthwatch” blog, and CNN (9/28).

Federal Employees See 3.8 Percent Increase. The Washington Post (9/28, Davidson) reports in its “Federal Diary” column, “Health insurance premiums for non-postal federal employees and all retirees will increase an average of 3.8 percent in 2012.” Yet “when your pay is frozen, as federal pay is through this year and next, the premium boost amounts to another hole in your wallet.”

CQ (8/6, Reichard, Subscription Publication) reported that CMS “officials said they have also updated data on an existing website devoted to hospitals in an effort to help consumers compare facilities. And they’ve added new information, including how well hospitals guard against infection during outpatient surgical procedures.” In addition, “the agency outlined a fresh set of goals for the ‘QIOs’ — the independent organizations that contract with Medicare to improve the quality and efficiency of care under the program.”

Modern Healthcare (8/6, Evans, Subscription Publication) reported that according to Berwick, the site “would allow ‘one-stop shopping’ for consumers looking for information on quality or the type of services provided by hospitals, physicians, nursing homes, home care or dialysis providers.” Also on Friday, the agency “released data…on hospital readmissions for heart attacks, heart failure and pneumonia that found little change in performance.” In fact, the data showed “only small changes to the readmissions rate, according to Medicare, which compared data for the years 2007 through 2010 against data for the years between 2006 and 2009.” The Daily Record (NJ) (8/7, Ungaro) also covered the story.

The tool provides average costs for 59 common elective procedures. Please refer to the list below. We believe this information will help members become informed consumers and take an active role when they have choices to make about their health care. Additional information and more medical procedures will be added to the tool later this year.

Frequently Asked Questions:
What is the Treatment Cost Estimator tool?
The new Treatment Cost Estimator is a web-based tool that provides members with information about the relative cost of 59 elective procedures. This tool gives our customers an estimated range of what a procedure may cost and provides them with information about how the cost may vary based on the physician/hospital they choose.

Can the tool be used for all BCBSNC plans?
Cost comparison information is not available to members on the following plans:
Medicare Advantage (Blue Medicare)
Medicare Supplement
FEP
Dental-only

What data is used to calculate the cost estimations?
Blue Cross and Blue Shield of North Carolina has joined other Blue plans across the country in providing new cost range information for various types of treatments and procedures based on network claims data.

The costs listed in the tool represent a range of the average treatment costs at a particular hospital. This tool calculates costs using a methodology which is broken into two components:

There are several steps involved in generating costs of a procedure at a particular facility. First, we collect claims data and categorize the information into cases of care. Cases of care represent a collection of services such as the doctors’ charges, the hospital charges, lab tests, etc. related to a particular procedure. Second, the cases are reviewed to remove any outliers/exceptions that may skew the averages. Third, cost bands/ranges are created for each procedure based on these averages.

Each office visit is assigned a code to specifically identify the procedure/service that is being provided. Costs are assigned to each procedure code; along with a standard rate based on the location (Zip Code) of the where the service takes place. This cost value is displayed within the application.

Is the tool intended to provide medical advice and exact payment information?
The cost information provided is intended to be used as a reference tool for our members’ convenience and is not a substitute for medical advice from or treatment by a medical professional for specific medical conditions.

Estimates are not intended to be an exact calculation of claim payment and do not contain all health benefit plan terms, conditions, limitations and exclusions that may apply to a member’s coverage. Also, estimates are not a guarantee of payment or prior approval for a particular service.

Members should not avoid getting health care nor should they make health care decisions based on the cost estimates displayed on this website. Only patients and their doctors can decide which medical decision is best for them.

Why is there such a wide variation in price for a certain procedure?
Doctors’ and hospitals’ rates may vary based on differences in selected treatment plans based on individual needs. This information is intended to be used as a reference tool for our members’ convenience and discussion with their doctors.

Why is BCBSNC introducing the tool?
Health plan designs increasingly require consumers to make informed decisions about their health care, and consumers do not always have the information to determine what they will be required to pay or why. The goal of introducing this type of tool is to support members as they consult with their physician and make decisions about where to seek the health services they need.

How do I use the new tool?
Blue Cross and Blue Shield of North Carolina members need to log into Member Services online at www.mybcbsnc.com to get treatment cost information. Once logged in with their Member ID and secure password, members can use our doctor or facility search to see cost ranges associated with specific practices or facilities.

Members may also use the Treatment Cost Estimator in Member Services to see the general cost range for 59 elective procedures, without selecting a specific physician or hospital.

For doctor or facility searches:
www.mybcbsnc.com and click on Find a Doctor at the top right of the web page.
Complete the fields to search for a doctor or facility.
Select a type of facility to choose a type of treatment or procedure.
Select your treatment from the category menu under “Get Treatment Cost Estimates.”
Click “Search” and look for the cost range information on the right side. You may open or close the search field area after the results are visible.

For general treatment costs:
www.mybcbsnc.com.
Make sure the first three letters of your Member prefix are correct in the first field.
Enter your ZIP code.
Select a type of treatment or procedure from the drop down menu.
Click “Search” for results. You may open or close the search field area after the results are visible.

How does the functionality change the tool I have been using?
In the provider search tool, in addition to obtaining name, location and distance to a provider, you will also be able to access relative cost information which represents the allowed amount for the service. You can use this information to get a general cost comparison depending on the physician or hospital you choose.

Will my provider have access to the information?
The tool is available to all BCBSNC members who are registered on Member Services. BCBSNC has notified all impacted providers regarding this information. Please feel free to share the information with your physician if you have questions and would like to discuss options for where you should have treatment.

Does the cost displayed include all services related to my treatment?
The treatment costs you see represent a collection of services such as the doctors’ charges, the hospital charges, lab tests, etc. related to a particular procedure. The cost generally includes all services related to your treatment; however, some follow-up care may not be included depending on your treatment plan.

Can I use the tool even if BCBSNC is not my primary insurer? The purpose of this tool is to provide cost comparison information between facilities. The relative value may not be as high if BCBSNC is not the primary insurer.

How often is the tool updated?The tool is updated every 6 months in April and October. Additional procedures will be added to the tool by the end of the year.

The CBS Evening News (8/1, story 8, 0:25, Pelley) reported, “Starting in 2013 most health insurance plans must provide free contraceptives to women. It’s part of the new healthcare reform law that also includes free annual physicals and HIV screening.”

The New York Times (8/2, A10, Pear, Subscription Publication) reports that the “standards, which also guarantee free coverage of other preventive services for women, follow recommendations from the National Academy of Sciences and grew out of the new health care law.” According to HHS Secretary Kathleen Sebelius, “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need.” Advocates of the new requirement “said it would go a long way toward removing cost as a barrier to birth control, a longtime goal of advocates for women’s rights and experts on women’s health,” yet, the new policy “does not immediately help women who have no health insurance.”

The AP (8/2) reports that the requirement, “affecting most insurance plans, is part of a broad expansion of women’s preventive coverage. Breast pumps for nursing mothers, an annual ‘well woman’ physical, counseling on how to avoid sexually transmitted diseases and other services will also be covered at no cost to the patient.” Notably, these rules “include a provision that would allow religious institutions to opt out of offering birth control coverage.”

The Washington Post (8/2, Aizenman) reports, “The rules issued by Health and Human Services Secretary Kathleen Sebelius amount to one of the most wide-reaching and potentially popular provisions of the health-care law adopted last year.” While announcing the changes, “Sebelius cast the new rules as part of a broader effort in the new health-care law to build a nationwide system focusing on prevention. But she also said they were crucial to another of the law’s goals: ‘to bring fairness to the health insurance market for women.’”

The Wall Street Journal (8/2, Adamy, Subscription Publication) quotes Sebelius as saying about the new rule, “Not doing it would be like not covering flu shots or any of the other basic preventive services.” The Journal points out that this was a victory for those who support broad-based access to contraception. In contrast, religious groups, the Roman Catholic Church in particular, voiced their displeasure.

The Hill (8/2, Pecquet) reports in its “Healthwatch” blog, “The new guidelines exempt group health plans sponsored by certain religious employers.” They “define a religious employer as a nonprofit that has the inculcation of religious values as its purpose, primarily employs persons who share its religious tenets and primarily serves persons who share its religious tenets.” The Hill notes that Sen. Barbara Mikulski (D-MD), “who championed coverage of women’s preventive care in the heath law, applauded Monday’s decision.” Mikulski “had written to Sebelius along with 28 colleagues urging the secretary to adopt the IOM recommendations.”

The Chicago Tribune (8/2, Graham) reports that the rules “delighted health advocates, alarmed the insurance industry and angered religious conservatives.” They rules are set to “become effective Aug. 1, 2012, and apply only to insurance plans newly started or significantly changed after that date.”

The Washington Times (8/2, Cunningham) reports that under the new rule, “insurers must cover all FDA-approved emergency contraception, including Plan B, the so-called ‘morning-after pill,’ but not RU-486, a more controversial pill that induces abortion. While some of those drugs are available over the counter, a woman would have to show a prescription from her health care provider to be guaranteed them free of charge.”

CQ (8/2, Adams, Subscription Publication) explains that what HHS issued on Monday was “an interim final rule…that incorporates” the IOM’s recommendations. “The public has 60 days to comment.” CQ adds, “The leader of America’s Health Insurance Plans, Karen Ignagni, didn’t specifically criticize Sebelius for largely adopting the IOM report.” Nevertheless, Ignagni “went after the Institute’s recommendations,” saying, “Unfortunately, the preventive care coverage recommendations recently issued by the IOM would increase the number of unnecessary physician office visits and raise the cost of coverage.”