Massachusetts Launches Health Care Shopping Experiment
To shop for health care, it would help to know what childbirth or a CT scan will cost ahead of time. But is it possible to actually list prices for medical procedures? And will patients armed with the information look for bargains when they seek care?
Massachusetts is trying to find out. Since Jan. 1, hospitals and doctors there have been required to tell patients how much things cost, if they ask. It's part of the state's health care cost control law. We set out to run a test.
Our shopper: Caroline Collins, a 32-year-old pregnant real estate agent from Fitchburg who is trying to compare prices for a vaginal delivery. Her first call is to the main number at Health Alliance Hospital in nearby Leominster. From there, she is transferred to the hospital's obstetrics department. A receptionist there tells Collins to call the billing office at UMass Memorial Medical Center in Worcester, which is part of the same hospital network as Health Alliance.
When a customer service rep answers, Collins launches right in: "I'm due in June and my husband and I have pretty minimal coverage, just a really high deductible, so I just wanted to check and see what the cost would be." Collins' deductible is $3,000 a year, but she expects the delivery to cost more than that. She just wants to know how much more.
Collins is directed to the extension of someone named Cathy, who apparently has the price list for services at UMass member hospitals. Turns out Cathy will be out for two weeks. Collins leaves a message, tries another number in the billing office and leaves another message.
She moves on to Emerson Hospital, where she's transferred from the main switchboard four times before leaving a message for a woman who has not called back after two days. Massachusetts law requires a callback within two days.
The only place where she reaches a person who gives her a price after one call is a natural birth center called the Birth Cottage. Their price: $3,000 to $5,000 for a normal vaginal delivery.
The third day, Collins hears from UMass Memorial. "She did give me an average price," Collins says. A vaginal delivery would cost "between $10,000 and $16,000." If her delivery turned into an emergency C-section, the cost would be between $20,000 and $30,000 "depending on the operation and how it went," Collins says.
Collins is told she will probably only have to pay her $3,000 deductible of whatever the price is in the end, but she's not sure. She's getting conflicting information about what is and isn't covered from her obstetrician, the hospitals and her insurer.
No one said this would be easy. Each hospital negotiates prices with each insurer. Sometimes the hospital and physician charges are separate, sometimes they are not. And what the patient pays on top of their premium varies if they have a deductible or coinsurance.
"The main thing I wanted to find out was whether I would have any surprises," Collins says. "I kind of wanted to be prepared for that. It sounds like I will be OK, but you never know until it's over, so I guess I'll find out."
"The experience was pretty frustrating from beginning to end," she adds. "It was definitely surprising how many machines I spoke to within the last few days."
Both Emerson Hospital and UMass Memorial Health Care say they are committed to making prices easily available for patients. A spokeswoman for Emerson says she was dismayed that Collins did not receive a prompt response.
Robert Brogna, a spokesman for UMass Memorial, says the hospital is "working through some challenges in the early days of the new requirements, and some interactions have clearly been less than optimal. This will change. In the coming weeks we will be providing a phone line and establishing new policies and procedures to support this new requirement."
"It's very different from, you go into Best Buy, you want to buy a refrigerator," says Karen Granoff, the senior director for managed care at the Massachusetts Hospital Association. Granoff says her members are working with insurers to nail down prices that hospitals can quote patients.
"They know they need to do this," Granoff says. "They are not opposed to the transparency. I think they are worried about the challenge of getting the information to the patient."
There's no enforcement mechanism in the law to make sure that hospitals and doctors are complying. But the state's undersecretary for the Office of Consumer Affairs, Barbara Anthony, says the time has come to put price tags on health care.
"It's kind of, ridiculous, is the word that comes to mind, that we're actually talking about the pros and cons of whether consumers should know how much their health care costs," Anthony says. "I mean what other commodity or service do we ever debate whether or not a consumer should know the price of a service before purchasing? You can't even name one."
This story is part of a collaboration among NPR, WBUR and Kaiser Health News.
MELISSA BLOCK, HOST:
Massachusetts is known as a testing ground when it comes to health care. And now the state has a new experiment underway. The idea is to find out whether health care providers can share the prices of procedures - for example, an MRI, stress test or the delivery of a baby - and whether patients armed with those prices change when and where they buy care. Since January 1st, hospitals and doctors in Massachusetts are required to tell patients who ask how much things cost.
WBUR's Martha Bebinger followed a patient who put it to the test.
MARTHA BEBINGER, BYLINE: Our sample shopper is a 32-year-old pregnant real estate agent from central Massachusetts. She sets out to get prices from three hospitals.
CAROLINE COLLINS: Hi, this is Caroline Collins. I'm just calling to find out about the price of a vaginal delivery in your OB department.
BEBINGER: The main switchboard at Health Alliance Hospital in Leominster...
COLLINS: Oh, thank you.
BEBINGER: ...transfers Collins to obstetrics, where a receptionist tells her to call the billing office at the parent hospital, UMass Memorial Medical Center in Worcester.
COLLINS: I'm due in June and my husband and I have pretty minimal coverage, just a really high deductible. So I just wanted to check and see what the cost would be.
BEBINGER: Collins' deductible is $3,000 a year. At UMass Memorial, Collins leaves a message for a woman who has a price list but will be out for two weeks.
COLLINS: And I hope you have a great time off and I'll see you when you get back. Thanks, bye.
BEBINGER: Collins tries another number at UMass Memorial and leaves another message. She moves on to Emerson Hospital, where she's transferred from the main switchboard four times before leaving a message for a woman who hasn't responded after two days. Into her third day of shopping, Collins finally hears back someone at the second hospital.
COLLINS: She said that the vaginal delivery would be between 10,000 and 16,000. And then if it turns into an emergency C-section it would be 20,000 to 30,000, depending on the operation and how it went. And she said that to give me a more exact number, she would need a CPT code, which comes from the doctor's office, I suppose.
BEBINGER: Your doctor's office has a code tied to the price of any test or treatment you need. And you need to know that code, a lesson Collins learned the hard way.
COLLINS: The experience was pretty frustrating from beginning to end. If was definitely surprising how many machines I spoke to within the last few days.
BEBINGER: All the hospitals Collins called say they are committed to complying with this new price requirement, which says they must quote patients a price within two working days but it's difficult. Each hospital negotiates prices separately with each insurer. Sometimes the hospital bundles all the costs into one bill, but sometimes the surgeon or anesthesiologist or lab sends their own bill. And then what you, the patient, actually pay on top of your premium varies if you have a deductible or co-insurance.
KAREN GRANOFF: It's very different from you go into Best Buy, you want to buy a refrigerator.
BEBINGER: Karen Granoff, with the Massachusetts Hospital Association, says her members are working with insurers to nail down prices.
GRANOFF: They know that they need to do this; they're not opposed to the transparency piece. I think they are worried about the challenge of getting the information to the patient.
BEBINGER: Doctors are also now required to quote prices for patients. Some large physician groups have purchased software that calculates a patient's exact expense. But many individual doctors say they haven't heard of this requirement. The state has no authority to make physicians or hospitals participate.
Dr. Ron Dunlap, president of the Massachusetts Medical Society, says giving patients prices is a good idea.
DR. RON DUNLAP: But I think this project is somewhat of an overshoot. It's just too broad. There are just too many different procedures. My thought is that we should focus on the most frequently used expensive procedures, and that's where most of the savings could be achieved.
BEBINGER: There are no plans to revise the pricing requirement. Barbara Anthony is Massachusetts Undersecretary for Consumer Affairs.
BARBARA ANTHONY: It's kind of - ridiculous, is the word that comes to mind - that we're actually talking about the pros and cons of whether consumers should know how much their health care costs. I mean, what other commodity or service do we ever debate whether or not a consumer should know the price of the item or the service before purchasing? You can't even name one.
BEBINGER: But you'll hear many doctors and hospitals say health care isn't like any other commodity. Collins is figuring that out. In the end, she only heard back from one hospital and didn't get anything close to an exact price for her delivery.
For NPR News, I'm Martha Bebinger in Boston.
BLOCK: This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.