Talking Price Transparency
Posted by Mitch Mitchell on Aug 2, 2008
There was an interesting article that popped up on the Medseek blog called Transparency At What Price.
Pricing transparency is the latest buzz word that basically means hospitals putting all their prices somewhere so people can see what they're charging for services. It's controversial for more than one reason. On one hand, back in the day hospitals weren't allowed to share their prices so openly because of possible charges of collusion, which means that they could be accused of working with each other to control the markets by negotiating with each other how they were going to charge for items. On the other, healthcare is one of the few businesses where people find out after they've had services performed how much they're on the hook for.
Anyway, many hospitals and physicians have decided to address this issue by putting their list of charges, known as a charge master, out on the internet, basically trying to show that they have nothing to hide. However, what's happening, which was indicated in the story I linked to above, is that the overwhelming majority aren't taking advantage of the information anyway. In the first year of Doylesberg Hospital in Pennsylvania setting up a process where patients could call to find out the price of services, they've averaged less than a call a day.
Does this mean that pricing transparency doesn't work? Well, in a nutshell, yes. Does it mean that hospitals should continue the status quo? Not necessarily. The thing with hospital services is that there are many where it works out well in telling people how much it's going to cost for their services. Most ancillary services such as lab and radiology services work very well.
Surgical and inpatient services are a different animal entirely. Surgical rates, as far as those performed in hospitals, are often billed on time, and though a hospital can estimate the time to some degree, it always depends on the surgeon and if any complications arise. Some surgeons are faster or slower than others, so prices can vary. Also, all supplies on implanted items aren't the same. Pacemakers, for instance, can run from $2,000 to $30,000, and it depends not only on the condition of the patient but a physician's favorite items to use. And one can only guess just how many supply items a physician is going to use during a procedure.
The same type of thing goes for inpatient stays. A hospital can tell people how much their normal room rate is a day, as well as how much for a private room, but there are different rates for different rooms, and if you get moved to ICU, a room with a ventilator, a radiation room, etc, the prices all differ. The lucky thing for most inpatient stays is that almost no one these days pays actual charges; the unlucky thing is that the amounts can still be pretty high.
Anyway, price transparency isn't going away any time soon. Politicians are starting to get into it, and of course they're getting it wrong, and things are going to get messed up. Truthfully, the best thing most people can do for themselves is to go see their physicians while they're feeling pretty good and get routine check ups. Healthcare costs stay low when you know what's going on with your body, and if diseases and other problems can be addressed earlier, life will be pretty good.
I think pricing transparency needs to start with physicians and other doctors. For example, I have to have a tooth pulled. My dentist referred me, but gave me no indication of what the cost might be. When I made the appointment, I had to ask what the cost might be and was given a range (depending on how difficult it is to get the tooth out).
When you have surgery or a test done, neither doctors or nurses say anything about cost. Okay, so test X is covered by insurance, but wouldn’t it be nice if they informed you about the cost anyway? You might even value the test more.
So for me, transparency needs to begin well before I get to the hospital. It needs to be in every medical office. It should be a part of every medical related conversation. Gee…yes, your exams costs X and this is the value you get for them…this is what you can learn from them…this is what you should expect.
Very good point, Jill. When I had breast surgery many years ago, I had no idea how much it was going to cost, only that I was going to owe some kind of co-pay afterwards. I wondered what someone without insurance might have to pay at the time. I remember asking, having someone tell me I would only have to worry about the co-pay, and because I was more nervous about the surgery than curious about the price, I let it go.
Of course, if you’re having elective surgery, you’ll definitely know how much it is, because the surgeon won’t perform it until he’s been totally paid. Hospitals still aren’t as good as collecting that money upfront as they need to be.
As a consumer of high-deductible health plan, along with a health savings account, I find myself shopping around for the best value in order to make the most of my health care dollars. It’s called being a good consumers. Unfortunatley, the lack of price transparency in the health care industry make it very difficult for consumers to look-up the true price of service before visiting a provider.
I created a community search tool, http://www.OutofPocket.com to help consumers look up prices, find the best value for routine health care services, and see what other consumers paid for similar services. The site collects price data from consumer-generated content, providers that disclose prices, Government CMS Medicare payment data and public websites that disclose prices.
Everyone is invited to use this site – and feel free to post/share prices you paid for actual services to share with other consumers.
I welcome all your comments.
Regards,
Mona Lori
founder
OutofPockt.com
Thanks for sharing, Mona. Pricing transparency came about because of folks like you with high deductible plans, as well as those with medical savings accounts. Still, I found it interesting that, based on percentages, there aren’t all that many people who are actually going out there and doing the research even when their hospitals have the prices easily available. It would be interesting to hear what the numbers look like as far as people who use your site for researching prices.