Leslie Ramirez, is a primary care doctor at Northwestern Memorial Physicians Group. She got frustrated prescribing medicines and tests for her patients and then finding at a follow-up visit that they had bought neither the medications nor had the tests. The problem was money. “Nothing had been accomplished. It was like banging my head against the wall,” Ramirez told me. She said that she would often prescribe a medicine that she knew was inexpensive at a local pharmacy and wondered why her patients were having trouble buying the drug. She soon learned that there is huge price variation for exactly the same medicine and that her patients might have been shopping at places where the prices were way beyond their means.
So Ramirez created a new website, Leslie’s List, to give the uninsured and underinsured in Chicago important price comparisons for prescription drugs and medical tests. A great example of entrepreneurship used to serve a common good.
I learned about the site from Jeff Bailey, a former Wall Street Journal and New York Times business reporter, who is married to Ramirez. The site his wife developed offers price comparisons of some 550 medicines that are commonly prescribed and prices for common medical tests offered by some 75 groups or businesses offering medical tests. Using volunteers—her friends’ mothers and college students—and making many calls herself, Ramirez updates the prices quarterly at such drug store outlets as CVS, Wal-Mart and Costco and at certified medical testing sites around Chicago. Price variations are staggering. Zofran, an anti-nausea drug costs $22 for thirty tablets at Costco and $648 for the same amount at Walgreens. The price of a CT scan of the brain varies from $259 to $2585. An echocardiogram varies from a low of $403 to a high of $2428. “It’s just crazy, but that’s what you’d expect from a totally opaque marketplace,” says Bailey.
Ramirez told me that she learned that doctors at Northwestern Memorial (which is not related to her practice) read some of the tests done at varied facilities. The same doctors are reading the $4000 study and the $400 study, she explained, adding that it was hard to get the prices from the hospitals. Often staff does not know the prices, or they forget to include the fees for reading the studies. Seems to me that Ramirez has hit on the inefficiency problem driving up the costs at too many of the nation’s hospitals.
This site is clean, clear, and to the point. About 5000 visitors a month come to it, including doctors, social workers, and others who work with patients. This site demonstrates the old adage that all health care is local, and it’s that specific local information that makes it so valuable.
One feature I especially like is the lists of free or low-cost clinics for people who don’t have a regular doctor and need care. The Find a Clinic section offers resources by neighborhood, with contact information and the services they offer provided by clinic. Such a listing should be available in every city.
But as Ramirez and Bailey have learned, creating such a site and keeping it current is tough on shoestring budget. They are paying for the site and the upkeep out of their current income, but are thinking about a business model to provide similar information in other cities. So far, they are spending less than $20,000 a year with a lot of free labor. “We want to be the place where the uninsured and the underinsured go for help,” Bailey explained.
Beyond help for individuals, Ramirez hopes that revealing the huge price differences for medicines and medical tests might force some sellers and providers to lower them—at least that’s what economic theory tells us will happen. “I believe we’ve impacted prices a teensy, weensy bit for medical testing,” Ramirez says.
As for getting pharmacies to reduce the prices of drugs, that may be harder. I checked in with the New York City Department of Consumer Affairs, which used to collect drug prices in New York City. Inspectors found big prices differences too, but in the end the sellers didn’t budge. The high-cost sellers continued to charge high prices, and the low-cost sellers continued to offer lower-priced drugs. If that continues to be the case, it’s still caveat emptor for consumers and patients, but sites like Leslieslist can make the shopping a little less perilous.
Aftershock:
The Center for Advancing Health is funded by
Leslie Ramirez’s inspiration to start this website came from her investigative work of determining why her patients were not filling their prescriptions or getting their prescribed medical tests. She took the initiative to determine what was preventing them from taking her medical advice and acted on a large problem in the medical field. This is important because there are reasons for “non-compliant” patients. If a recommended health behavior is not performed, it may be because there is a larger obstacle that a person has to overcome in order to take the initiative to act. I am impressed by her desire to research further her patient population.
Ramirez also tackles a large problem, health care costs, with a simple solution, a website. Many may be overwhelmed or helpless learning that a CT scan costs $2,585 or a prescription costs $648. What can consumers do about this? Exposing this information is the first of many important steps to reduce health care costs. Using her personal money and energy in addition to volunteers, friends, and college students to launch this website demonstrates how grass root community efforts can have a large impact on a community and provide an impetus for change.
Great information. I’m so thankful for people who find it compelling to seek the truth, who are without agenda, and without(much) self, who have energy and drive to serve.
A mission I’ve recently come into is to understand others who apparently are on the opposite side (or many sides) of this energy. They too have their story and their wisdom, even if it is upside down from my own. This is most hard.
Thank you for this. I will promote it as I also want to serve.