Cost is a big question, and here’s an answer

Print Friendly and PDF By: Andy Miller Published: Jun 2, 2014

Millions of Americans have no health insurance. Millions of others have health coverage that includes high deductibles.

Both these groups often have to pay upfront for the whole cost of a medical procedure or a visit to a doctor. And these prices can have wide variation, even within a single community.

Healthcare CostYet there’s little if any information publicly available that helps such individuals compare prices.

Three major health insurers are doing something about that. UnitedHealthcare’s parent company, along with Humana and Aetna, are leading an industry initiative
to make medical price information available to consumers on the Internet.

The independent nonprofit Health Care Cost Institute will create and administer this online portal, expected to be available in January.

Separately, a health care website Monday rolled out some price information for people who “self-pay” — or have no insurance — in various markets around the country.

Georgia consumers can find out what the estimated self-pay price is for procedures at facilities run by the hospital chain HCA on clearhealthcosts.com.

Jeanne Pinder, CEO of Clear Health Costs, has taken information from publicly available sources for her website. HCA has put this data on its website for years.

The procedures covered are a mix of inpatient, such as childbirth, and outpatient, such as mammograms.

HCA has seven acute-care hospitals in Georgia, plus outpatient centers. The cost of “mammogram routine screening” ranges from $14 at Cartersville Medical Center to $135 at Doctors Hospital of Augusta, according to clearhealthcosts.com.

These are estimates of out-of-pocket costs for the uninsured, Ed Fishbough, an HCA spokesman, told GHN on Monday. “We’ve been doing this for a while.”

But the Georgia data are almost strictly from HCA facilities.

Pinder wants to increase the quantity of the data. “Some of these providers include doctor and anesthesiologist prices in their listings, and some don’t,’’ she said recently. “Of course, that means it’s hard to compare. That fact notwithstanding, we think the prices are interesting. Even partial transparency, we think, begins the conversation, and lets us hope for more.”

An analysis from the Gary and Mary West Health Policy Center released in May said that providing patients, physicians, employers and policymakers more information on prices could reduce U.S. health care spending by an estimated $100 billion over the next decade.

Some states have enacted their own health price transparency laws, but Georgia is not one of them. A March report card on price transparency gave it and 44 other states an “F’’ grade.

The grades were produced in a joint effort by the Catalyst for Payment Reform, a group of employers such as Atlanta-based Home Depot, General Electric, Walmart and AT&T, and the Health Care Incentives Improvement Institute (HCI3), an organization seeking to improve health care quality and promote payment reform.

“Some states have robust price transparency laws and regulations, requiring them to create a publicly available website with price information based on real paid claims information,’’ the report card stated. “But in reality, the public can’t readily access that information because the website is poorly designed, or poorly functioning.”

The Georgia Hospital Association said Monday that it supports more price transparency. Medicare has begun releasing data on costs of services and how much physicians are paid.

 

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Meanwhile, the Health Care Cost Institute expects more insurers will join the pricing data push by UnitedHealthcare, Humana and Aetna.

The new transparency tool that HCCI is developing will aggregate pricing data from commercial health plans, allowing consumers easy access to the information.

David Newman, the executive director of the Washington-based organization, told GHN on Monday that “there is certainly the belief that consumers are more interested in medical cost.”

Consumers will be able to tell what prices are being paid by the insurer and individual to hospitals. In some states, consumers will be able to compare the price of a regular doctor visit to that of a trip to an urgent care facility.

Newman says the goal is to provide a health care equivalent to the car-buying website Edmunds.com.

The participating insurers’ customers will get more detailed information about prices, including how much they’ll have to pay out of pocket.

The price of medical care is just one factor in choosing a provider, Newman said, noting that two other factors are quality of care and convenience. (Convenience would include such issues as a facility’s operating hours and distance from the consumer.)

But increasing the availability of price information is important in itself. Katherine Hempstead, a senior program officer at the Robert Wood Johnson Foundation, told Modern Healthcare, “The potential is enormous. It’s just a tremendous public service.”

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