The document describes a game to be played by medical residents to help increase their awareness of healthcare costs. It will involve teams bidding on the costs of common medical scenarios and procedures. The team that bids closest to the actual costs wins points. The document provides background on national healthcare expenditures and examples of several medical cases involving women's health issues. For each case, it lists the relevant tests, procedures, and their associated costs to the hospital to help the teams in bidding.

1. The Price is Right! Shilpa Iyer, MD MPH 12/27/11 Gyn style

5. National Health Expenditures per Capita, 1960-2009 Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip).

6. Per Capita Total Current Health Care Expenditures, U.S. and Selected Countries, 2008 ^OECD estimate. *Differences in methodology. **Based on 2007 data. Notes: Amounts in U.S.$ Purchasing Power Parity, see www.oecd.org/std/ppp ; includes only countries over $2,500. OECD defines Total Current Expenditures on Health as the sum of expenditures on personal health care, preventive and public health services, and health administration and health insurance; it excludes investment. Source: Organisation for Economic Co-operation and Development. OECD Health Data 2010, from the SourceOECD Internet subscription database updated October 2010. Copyright OECD 2010, http:// www.oecd.org/health/healthdata . Data accessed on 01/06/11.

7. The Costs The Patient The Hospital Insurance companies

13. New Gyn Patient Clinic Visit $317

14. CBC $85

15. TSH, +/- free T4 TSH: Free T4: $179 $95

16. Pap Smear $161

17. Endometrial Biopsy $566

18. Pelvic Ultrasound $ 700 In the ED: $1400

19. Office Hysteroscopy $3338

21. If we couldn’t do an office hysteroscopy or saw something… To the OR! Diagnostic hysteroscopy/D&C: Hysteroscopy w/ polypectomy $13,621 *Dr. Federschneider $12,466 *Dr. Federschenider

23. TAH? $78,812

25. TLH? $26,403

30. Wet Prep $46

31. Urine dip in the office $27

32. UA $23

33. Urine Culture $87 w/ Susceptibilities: $73 per isolate

34. Cervical probe for gonorrhea and Chlamydia $277 each! billed separately

35. Vaginal culture $91 for aerobic bacterial + $73 for each susceptibility Or $91 for gram negatives because of different MIC cards used

36. Vaginal fungal culture $89

37. Urine Hcg in the office $67 (test & MA time) Serum Hcg... for all of the Ectopic List players... $160

39. Office IM ceftriaxone RN IM Injection Drug cost: $212 $1 + 4x hospital markup

42. Early 1 st trimester D&C at FPC $3,022 (for 8-12 wga) Includes: hospital charge & $141 US fee

44. & For the pathology? $120 from Pathology Associates If the fetus has any abnormalities, the fee may be as high as $370

45. How about 1 st trimester D&E at Lolly’s?? $600 Self Pay

46. What if she were 18 wga and needed laminaria at FPC? $3490

47. 18 wga with laminaria at Lolli’s? $1450 Between 14-through 16 weeks it's $950 and through 17 weeks it's $1065

49. Mirena Paraguard IUDs IUD: $700 ($2800) Insertion: $1038 IUD: $568 ($2400) Insertion: $1038

50. Depo Provera RN IM Injection in clinic: $212 Medication Cost: $21 (x4 = $84)

51. Implanon: Device only... $660 (x4 = $2640)

52. Essure in gyn clinic: Device: $4,820 Procedure: $4,071 $8,891

53. The Tally!