Jayne O'Donnell, USA TODAY 8:48 p.m. EDT April 27, 2016
Huge variations exist in the prices of some of the most common medical procedures across state lines, according to a report major insurers released Wednesday, but some experts say the data is of little use to consumers who rarely know what they owe until the bills arrive.
The insurer-funded Health Care Cost Institute (HCCI) won’t disclose which hospitals or doctors are the high-price culprits and instead are releasing how much states' average prices differ from national average.
California, for example, has average prices that are the same as the U.S. averages for dozens of the most common procedures, including pregnancy ultrasounds and cataract surgery. But Clearhealthcosts.com, which compiles prices in 10 metro areas using data from consumers, doctors and hospitals and its own staff members' research, finds a huge price disparity within a 100-mile radius of San Francisco for some procedures.
The cash price for a lower-back MRI without dye ranges from $475 at the Castro Valley Open MRI to a whopping $6,221 at the University of California, San Francisco at Mt. Zion. Patients pre-paying or paying on the day of service at UCSF, however, get 40% off.
Some say HCCI's transparency effort doesn’t go nearly far enough now that consumers are paying for so much of procedure costs out of pocket given high deductible plans and cost sharing. Average state prices — and how they compare to national averages — may not be enough as cost transparency becomes a hot topic in state legislatures and in Washington.
"Knowing the average cost in your own town is useful if you’re a researcher, maybe, but it doesn't help consumers make decisions," says David Vivero, founder of Amino.com, a physician search tool. "You still have to call 10 doctors." The new data should at least alert consumers in states such as Maine, Virginia, North Carolina and New Mexico that they need to shop around as prices are far higher than the national average.
HCCI has claims data representing about 25% of the commercial market and includes most major insurers except Blue Cross Blue Shield, which releases its own data. HCCI couldn't release the doctor or hospital-specific prices consumers could expect to pay because of antitrust issues, says HCCi executive director David Newman. Even though HCCI is independent of insurance companies, Newman says it would still need to partner with a state to release prices for different facilities.
Guroo.com, a consumer site operated by HCCI, gives average state prices for more than 300 procedures.
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In Massachusetts, health cost transparency is the law. Since early last year, hospitals and doctors were given 48 hours to provide detailed pricing estimates to consumers who ask. But adherence has been challenging and Neel Shah, a Boston obstetrician and gynecologist who is an assistant professor at Harvard Medical School, says the law set off a scramble across the state as many hospitals had to figure out how to quickly answer patient questions.
Some other states require some level of transparency, including New Hampshire, California, Minnesota and New Jersey.
For insurers to release more data would require them to disclose more clearly how their own deals with health care providers leave some consumers paying several hundred or thousands of dollars out of pocket for some procedures.
One example of the problem: Colonoscopies that can cost 50 to 100% more just because it's done at a hospital rather than an independent surgery center.
"Everyone has to produce the same work product," says Fred Rosenberg, a Chicago gastroenterologist who is president of the Digestive Health Physicians Association. "The more patients become more knowledgeable consumers of medical care, the more we can get these places to be upfront about their prices."
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