I attended my first #HCLDR tweetchat recently, enticed by the topic of healthcare price transparency and a recent diagnosis that will soon send me in for outpatient surgery. Needless to say, my interest in the cost of healthcare services has intensified. While I do have insurance, that’s not to say that the expense will be tolerable. I have asked for every office involved to give me detailed explanations of what my estimated charges will be, how they arrived at those figures, how those figures might change, and what my percentage of those charges will be based on my insurance plan. And then I asked everyone to explain everything again. Luckily, I had the time and the resources to keep asking questions.
I even called another facility in the area to see if their estimates were competitive. That led me down another rabbit hole of inquiry. To truly know what you’ll pay for at a hospital, you not only have to take into account the hospital’s estimate, but also know that you’ll likely also receive a bill from the surgeon, lab, anesthesiologist, and pretty much any other –ologist you come into contact with – all of whom are likely contracted with the hospital, rather than its full-time employees. There was even a sign to this effect when I went in for my pre-op. No wonder patients feel so bewildered and slightly intimidated when faced with the cost of treatment.
Where does the money go? Who gets paid what for which service? If the hospital’s chargemaster says this, but writes down 50% of it due to contract with a payer, then what is the procedure’s true value? I was quoted $18,000 for one procedure, which was then whittled down to just over $3,000 after contract pricing and insurance plans were taken into account. That seems a little off to me. Was there ever a time when a hospital charged a patient what a procedure was worth? And what about patients that can’t afford care? I was candidly told by a hospital employee that sometimes those that don’t have coverage end up paying less than those that do. I’ve never been good at math, but to me, this just doesn’t add up.
I’m not the only one who has questions when it comes to healthcare price transparency. I’ve listed below some of my favorite tweets from the #HCLDR chat, and hope that you’ll find them pertinent to whatever healthcare situation you might find yourself in. (Special thanks to #HCLDR co-founder Colin Hung for Storifying the chat, thus providing me with screenshots of the tweets below. You can view the full Storify story here.)
Hello Jennifer.
Excellent post and points. It’s a bit bewildering how an $18K cost goes down to just $3K. I’ve also often wondered how and where the money flows. It’ll be interesting to see if healthcare goes down a similar path to non-profit organizations and charities. Those entities have to publicize where their donations go and what % is spent on actual “works” versus “admin”.
Thanks so much for joining the #HCLDR tweetchat on healthcare price transparency. It was a great discussion and there were definitely a lot of ideas that were bantered around. Appreciate the mention and the shout-out in your blog post.
Interesting discussion, and your point is well taken, but you muddied the waters a little by using terms like “true value” and “what it’s worth”. Value/worth is in the eye of the patient. If I need life-saving surgery, the value to me is probably way higher than even the chargemaster price. But that’s irrelevant to your point. What you want to know is the final cost to you, and how you can minimize that.
It’s interesting that you tried to get competitive prices. 20 years ago very few people did that; now more people are trying. But they are discovering how hard it is to do (one provider told me that their contract with a major insurer forbids them from quoting the price unless you are scheduled for the procedure there). Price transparency is a hot topic, and there are companies trying to make a business out of publishing prices. It will be an uphill fight, but it is coming.
What is even harder is finding good competitive metrics on quality. Without that, price transparency is not truly useful. Any thoughts on that would be welcome.