SUMMARY: Can transparency be infectious? And when is transparency not so transparent? The world of hospital pricing is notoriously opaque and resistant to change. But the forward-thinking Surgery Center of Oklahoma has had online price lists for some time. Just recently we noticed that their neighborhood has a number of providers with online price lists–not just for an MRI, but even prices for a common surgery like gall bladder removal or bunion repair.
Here’s one: McBride Orthopedic Hospital has this price list. How much does an MRI cost, for example? For those of you keeping score at home, their price for a lower back MRI without contrast, known by the billing code number 72148, seems on the robust side: Either $750 or $675 (both prices are listed). The Medicare price for Oklahoma for that procedure is $377 — useful because the Medicare price is the closest thing to a fixed or benchmark price in this marketplace. Here is our list of New York area MRI prices, and list of Houston area MRI prices. (We’re not in Oklahoma yet, but it’s interesting to see that New York and Houston cash prices significantly undercut Oklahoma ones.)
[Update: This post about a Washington State man’s surgery experience has some details about gall-bladder surgery costs.–editor]
What’s interesting: these prices aren’t listed on the provider’s website in every case. Oklahoma Surgical Center, yes, but McBride Orthopedic has its prices not on its own site, but here in a page on the Advantage Health Plans Trust site; Advantage Health is a self-funded multiple-employer plan, a nonprofit “providing health programs for Oklahoma and Texas community banks for over 30 years,” according to the site. So it’s not clear that anybody but those covered by AHP would get those prices. I couldn’t find the list anywhere on the McBride site.
Oklahoma Heart Hospital has also joined the transparency movement, but not on its public site that we could find other than a promise of an all-inclusive treatment plan with price for international patients on this page, but you have to call for details. Scouting around a bit more, we found their price list here on the website of the Kempton Group, which is a third-party administrator for self-funded group insurance plans in Oklahoma and Texas. In other words, these prices apply to
people whose employers are members of the Kempton Group. If you’re not one of them, and if you can find these price lists, then ask if the prices will apply to you, that’s a measure of transparency.
Cancer Specialists of Oklahoma also lists itself on the Kempton price list, but is somewhat coy: you have to call for prices.
Breast Imaging of Oklahoma, another Kempton entry, also doesn’t seem to list prices on its site. Their Kempton Group price list, which is here, collects a range of common prices. One is the digital screening mammogram, at $171.50; Medicare pays $123 in Oklahoma for that. McBride Orthopedic is also on the Kempton site. Again, New York mammogram prices (here’s our list) vary widely but many are lower, including Memorial Sloan-Kettering, the premier cancer center in New York City.
That’s six providers in all on the Kempton site, and of them only one, Surgery Center of Oklahoma, lists prices on its site for one and all. So it’s transparency of a sort.
What’s up with that? Well, some providers who accept Medicare and Medicaid say that it is illegal for them to list prices publicly. We haven’t been able to definitively establish that. The Surgery Center of Oklahoma doesn’t take Medicare or Medicaid, and they say that frees them to list prices. We know that providers are often not free to publicize their negotiated rates via insurance companies, because of nondisclosure agreements, but cash prices seem to us to be different. (We’re scouting around for any federal or state statutes about that, and if you know of them, please let us know. We have seen numerous providers listing prices, and many of them indeed take Medicare and Medicaid, so we’re a bit confused about the law.)
Also, some transparency moves come from the states. In California, hospitals must post their list or “chargemaster” prices — but most people don’t pay those prices, because either their bills are paid at the “negotiated rate” attained by their insurance company, or they are uninsured or underinsured and therefore qualify for price breaks based on California law. Here’s a great article explaining this by Stephanie O’Neill at KPCC public radio.
In Minnesota, there’s another kind of transparency: This site reflects information about the average cost of 88 common procedure in Minnesota clinics, and adds links to several major health insurance plans, so consumers can get specific information about their health plans.
But state regulations like that are the exception to the rule, so transparency is coming elsewhere in fits and starts. In Las Vegas, we find No Insurance Surgery, specializing in hernias and mesh repair — and uninsured patients. The site tells us that Dr. Kevin Petersen “has been performing surgery for uninsured patients for his entire twenty-five year career. Recently the number of patients seeking this kind of care has dramatically increased and in response to this Dr. Petersen has formed No Insurance Surgery, Inc and now only accepts new patients without insurance. (He has, however, retained all of his old insured patients.)”
No prices are quoted online, though. So that’s, well, um, is it transparency?
The site explains: “We do not publish the cost of hernia surgery. Instead, we give a guaranteed price quote after the doctor has interviewed you. This means that the inclusive price you are quoted does not change after you come see us. Your telephone consultation with the doctor is free of charge and usually takes about 15 minutes.
“If you are shopping for the best price for hernia surgery we caution you to insist on a guaranteed inclusive price quote before you travel. Unfortunately we have heard of patients traveling based on an advertised price “$2295 Special This Month” only to find out the real price is over $6,000 once they get there.”
This practice also offers eye surgery (cataracts, eyelid lifts etc.); spinal surgery (injections, discectomy, laminectomy); hand surgery (carpal tunnel, trigger finger, joint replacement etc.); and gall bladder surgery without insurance. In all cases, though, the site says they don’t publish cash prices — patients must have a consultation first. We’re still not sure that qualifies as transparency.
This brings us to Dr. Allan Kravitz, whose practice in Rockville, Md., offers fixed-price hernia surgery to uninsured patients.
“Where someone typically might pay $6,000 to $9,000 at a hospital to repair a hernia, he charges a flat $1,900 fee,” writes Steve Twedt in The Pittsburgh Post-Gazette. “His approach is simple, yet it has a revolutionary feel — after getting a local surgical center and anesthesiologist to buy in on the set-fee idea, he has squeezed every efficiency he can into a procedure that takes about one hour to complete and rarely has complications.”
And finally, there’s Rochester General Hospital in upstate New York. Here’s a pricing page in clear language with coding information: A routine screening mammogram is $113; other prices are also listed, some with caveats (“The following represents hospital charges for uninsured patients, effective March 2012, and may be further discounted based upon income and family size. For information on Financial Assistance, click here. … If you are insured, you will benefit from the discounts that have been negotiated with your insurance company.”
With that, let’s close by asking how much does a gall bladder removal cost? At Rochester General, $6,134.04. At Surgery Center of Oklahoma, $5,865.
How much does it cost to fix a bunion? At McBride, $4,125. At Surgery Center of Oklahoma, $4,125.
How much does it cost to do carpal tunnel surgery? At McBride, $2,720. At Surgery Center of Oklahoma, $2,750.