There is a blizzard of questions flying in any health care transaction. From “How are you feeling?” to “Is this a side effect?” to “When would you like to schedule your appointment?” – questions aren’t in short supply. In my last post, I asked the big question that isn’t on the lips of many patients: “How much is that?”
Now it seems that question is on more lips. In the three months since I first asked it here, a number of stories have emerged that show consumers are more interested in cost details than they have been before. Getting that question answered, however, is still a big challenge.
Just last week, on Feb. 13, 2013, the Journal of the American Medical Assn. published an article about the difficulty of getting cash pricing on a hip replacement from U.S. hospitals. The prices at the 100+ facilities that answered the question ranged from $11,100 to $125,800. How is a consumer supposed to make a decision based on that wide an array of pricing?
It’s a little easier when you can add hospital quality metrics from a resource like Medicare’s Hospital Compare site, but what if the top hospital in your area isn’t one that can answer the cost question? Martha Bebinger, a reporter at WBUR in Boston, tried to be an engaged, empowered patient in August of last year when she was scheduled for an MRI to figure out why her migraines were increasing. She just wound up with a worse migraine, and a guess-timate from Mass General of just over $5,000. Lucky for her, she’s got no-deductible health insurance coverage, so the MRI was only going to cost her $25 out of pocket.
Someone like Dave deBronkart – known as e-Patient Dave in the world of participatory medicine – has to ask the question, and get it answered, to ensure both his physical and financial health. Dave is a survivor of Stage IV kidney cancer, and as such has both a high-deductible insurance plan and a need for comprehensive scans from time to time. He talks about the difficulty of getting accurate price information on his blog frequently, and as he approached the 5-year mark since his successful treatment, he talked about the challenge of getting pricing information on the full set of scans he needed.
It was a trip through the looking glass. His insurance company couldn’t help him, saying they wouldn’t know what would be charged until they got the billing codes from the hospital. He Sherlocked around, gathering prices – with significant difficulty – on all the pieces of his scan puzzle from the various players involved. Then, by pure chance, he found out about a radiology clinic nearby that actually posted their prices! You can read the whole story here, which is a deep, informative, entertaining dive into the Alice-in-Wonderland experience that is getting the “how much is that” question answered in U.S. health care.
What’s the fix? It won’t be quick, but there are glimmers of light through the murky looking glass.
There’s a startup called Clear Health Costs that’s currently in beta on a crowdsourced resource for anything that has a medical billing code attached to it. The resource will include geographic location, allowing consumers to comparison shop within their metro area.
There’s a non-profit, Costs of Care, that’s working to educate consumers and the health care industry on how to create and assess value in medical care, including cost transparency.
And, taking a page – literally – from the auto industry, there’s Healthcare Blue Book, which is a free guide to “fair price” information on medical procedures, with the results tied to your location.
Using all three resources simultaneously would make you a very informed health care consumer. So, go do that! Create grassroots change, and we’ll all reap the rewards. No Mad Hatter required …
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