Original Medicare Recipients: Learn how our Open Data Site can Save You Money

Consumers under Original Medicare can save money by becoming  more engaged in their healthcare.

Our mission is to bring publicly available data (also known as “open data”)  to the masses while helping them become more engaged in their healthcare.  Our site allows consumers to compare historical Medicare prices for over 6,000 procedures.   And it’s easy.  Just search by service specialty and zip code.   Explore doctors in that specialty and the various procedures they have performed.  Then compare average out-of-pocket costs.

What’s an example of how we can save you money?

In 2012, New Hampshire doctors performing total knee arthroplasties  (repair of the knee joint) for consumers enrolled in Original Medicare were compensated $2,729,306.40.  Medicare (CMS) paid over $2,162,602 or 79.2% and consumers paid the remaining $566,704 (20.8%) out of pocket.  In total, 2,739 arthoplasties were performed for patients enrolled in Original Medicare.

The average  out-of-pocket expense for consumers was $206.90 25% of consumers (685) undergoing the procedure paid an average of $311.77 out-of-pocket.

This means the average out-of-pocket for a consumer paying $311.77 was over 50% or $104.87 higher than the average.   A large contributor to the cost difference  may be attributed to overhead expense s at the doctor’s practice.  (Medicare reimbursements are a dry and complicated topic, but we will write about Relative Value Units at a later time.  But provider practice overhead is a large driver determining how much a physician will be reimbursed.)

This link is for one NH-based provider that performed knee joint replacements in 2012.  Clicking on any of the blue hyperlink CPT codes enables consumers to compare historical average out-of-pocket costs.


source: data.medicare.gov

Comments are closed.