How much does childbirth cost? Or an MRI? Our hospital data

Summary:  How much does childbirth  cost? How much does an MRI cost? Gall bladder surgery, arthroscopy? Today we’re rolling out our database of cash or self-pay hospital prices. While we’ve been collecting pricing for modest “shoppable” procedures since our founding in early 2011, we are now launching a separate database of cash or self-pay prices for more expensive, typically hospital-based, procedures. (Updated March 2017.)

 

 


The source of this information is the hospitals and surgical centers themselves: one big for-profit hospital chain, Hospital Corporation of America, and also other hospitals and surgical centers posting online prices, including these and others: Surgery Center of Oklahoma, Regency Healthcare in New York City, Rochester General Hospital in Rochester, N.Y.; Banner Health in Arizona.

The procedures are a mix of in-patient (childbirth, treatment for chest pain) and outpatient (mammogram, MRI, endoscopy). Different hospitals and surgical centers do different procedures, of course. Many states are represented, some with one provider and some with many.

The pricing comes with conditions or caveats. Surgery Center of Oklahoma posts its prices online, and describes its prices as binding and guaranteed. HCA posts prices online and describes them as estimates only. Each of the other sources of pricing has its own conditions and stipulations; Rochester General, for example, is clear to say that doctor and anesthesiologist will charge separately. (Update: Rochester General has removed its prices from its web site, and replaced its pricing with a page offering to quote an estimate.)

Why are we listing prices?

Why are we doing this? Because  it’s important for people to know what things cost in health care.

Why do the hospitals and surgical centers do this? Clearly, they agree.

Also, it’s good for business.

HCA says on its website: “HCA is pleased to introduce our pricing transparency initiative. To best serve patients and provide a meaningful estimate of out of pocket expenses, our information is specific to each hospital. … This is a groundbreaking healthcare initiative and we hope, through the information found on our site and our toll-free phone line to our Service Representatives, patients can learn more about the financial side of their healthcare needs.”

Surgery Center of Oklahoma says on its website: “It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive. …

“Transparent, direct, package pricing means the patient knows exactly what the cost of the service will be upfront.”

We asked Dr. Keith Smith, a co-founder of the center, about his practice.

“We wanted to show that an ambulatory surgical center could do these procedures for one-tenth of the price,” he said in a phone interview.  “We wanted to show that free markets do apply in health care, contrary to what people think. We wanted to start a price war, get some competition. Indeed that’s what’s going on.

“There are a few that are putting prices online. There are a lot that are about to. In the next 12 months, you’ll see a lot of price displays, all over the United States.”

Another surgical center that displays prices is Regency Healthcare in New York City. Dr. Robert Haar, founder, said in an email interview: “We began posting our prices in September because we wanted to let employers and patients know what medical care SHOULD cost. Historically, there has been very little in the way of transparency with insurance and hospitals….

“We want patients to be able to shop based on price and quality and the first piece of that equation is knowing upfront what the costs will be.”

We reached out to Hospital Corporation of America for comment several times. The person listed as their chief media contact, Ed Fishbough, did not respond to repeated emails and phone calls asking for comment.

The hospital and surgical center pricing pages and policies

HCA pricing comes from this web site: each individual hospital has a pricing page. The pricing policy is described on this page, which is reproduced on each hospital site: prices are only estimates, and are not binding. HCA has been listing prices for some time, beginning in Dallas in 2006. This was apparently a response to an executive order issued by President George Bush about transparency; the Federal Register reference to that order is here.

The Surgery Center of Oklahoma pricing policy is described on this page.

The Southwest Orthopedic pricing policy is described on this page. (Update 2017: Southwest Orthopedic no longer lists prices publicly, but it does offer to quote prices.)

The Regency Healthcare pricing policy is described on this site.

The Good Shepherd pricing policy is described on this page. (Update 2017: Good Shepherd no longer lists prices publicly, but it does offer to quote prices.)

The Rochester General Hospital pricing policy is described on this page. (Update March 2017: While the prices are no longer posted on the site, the hospital offers on this page to give estimates, and also says that a listing of representative prices is available on request.)

The Affordable Hernia Surgery pricing policy is described on this page.

(Update, March 2017: While a number of hospitals and surgical centers that did post prices in 2014 no longer do so, a larger number of hospitals and surgical centers have begun listing prices. The relatively new Free Market Medical Association has begun showing prices posted by its members on a search page here. The association was founded by Keith Smith of the Surgery Center of Oklahoma and Jay Kempton, who runs a health insurance agency in Oklahoma City.)

(Among the many interesting things about these several dozen providers: Some post prices publicly on their websites, as the Surgery Center of Oklahoma does. Many others do not appear to post prices publicly on their sites, but invite patients to get in touch for an estimate (Arctic Spine, in Anchorage, Alaska). Others list prices on the F.M.M.A. site, but not on their own sites (Ardmore Regional Surgery Center in Ardmore, Okla.). Some, like Blossom Bariatrics of Las Vegas, Nev., are listed on the F.M.M.A. site but have no prices there, and are often in the business of providing care that is cash-based, or often not covered by insurance.

(We have asked the F.M.M.A. if we can have their pricing data. There is no answer yet.

(We have sought to update our own database, while not discarding the historical data that is no longer publicly posted. In the interest of full disclosure, though, we wish to be clear that we don’t know if these providers still honor these prices. We do know, from a conversation with Keith Smith at Surgery Center of Oklahoma, that he has not raised his cash prices in nine years; he told us that he has changed prices several times, but in each case it is to lower them. In our experience, also, the cash or self-pay prices for the common, “shoppable” procedures that we survey on regularly do not increase significantly year over year.

(Also, while some of this pricing data may be out of date, it’s still “directional” — meaning that you can collect some meaning out of it, even if we do not guarantee that it is fully actionable.

(In every case, whether someone has quoted you a cash price or whether you found it here, you should talk to the provider, get a cash price, and get it in writing.)

In our database, in the notes field for the hospital in question, we’re putting a link to their pricing policy, so you know which conditions apply.

Only hospital prices, and not doctors or anesthesiologists?

Some of these providers include doctor and anesthesiologist prices in their listings, and some don’t. Of course, that means it’s hard to compare.

That’s true, but the prices are interesting. Even partial transparency begins the conversation, and lets us hope for more.

Also, we have learned that the hospital prices can be by far and away the most expensive part of the experience. Justin Evans, a Washington State man who had an emergency gall-bladder operation, gave us insight into his hospital billing experience when he wound up with a $6,104.64 co-insurance and deductible bill for his 13-hour hospital experience recently.

As you can see from his spreadsheet here, the hospital’s charges were $44,487.10, while the surgeon charged $1,250 for the operation and $365 for inpatient care; the anesthesiologists charged $1,425.

Gall bladder surgery cost

Given Evans’s experiences, then, having the hospital charges, added to the surgeon and anesthesiologist charges, might have given him a much smaller bill (and perhaps a much smaller co-insurance bill, though not necessarily).

Other transparency initiatives

Hospitals, of course, are required by some state laws to post their prices. But the conditions for posting prices differ from state to state. (Here’s a good state roundup on what regulations look like on that.) Even if they are required to disclose, few do — or they disclose their chargemaster or “sticker price,” which is generally assumed to be wildly inflated. That’s what typically happens in California and Ohio, two places where transparency is mandated by law. (Update 2017: Here’s our survey of All-Payer Claims Databases, which many once thought would bring transparency, but have not really done so in many cases.)

A bit of background might be useful. Quite often, the billing process goes this way: an insured person has a procedure. The hospital sends a bill with the “sticker price” to the insurer — either a private insurer or a government one, like Medicare or Medicaid. The insurer pays a previously negotiated rate, which is considerably lower than the sticker price, and perhaps the insured person pays a portion of it. That negotiated rate is a secret between hospital and private insurer, by contract, or in the case of government-insured patients, publicly disclosed by law but a price that’s unavailable to non-government patients. But an uninsured person might be asked to pay the sticker price.

In contrast, the hospitals listing their prices here say these are cash prices for self-pay patients — not prices that insurance companies can use. Providers often say that they can’t list their “real” prices — what they would find acceptable from a self-pay patient — because if they did, insurers would discount their payments off that lower, “real” price. Therefore, they say, they must publicize only their higher chargemaster price.

There was some data we found online but didn’t include: prices that are posted  but are clearly available only to participants in a given plan, like this one from McBride Orthopedic in Oklahoma City.

For further information on pricing services, you can take at them, and also look at our “useful links” page, where you’ll find a collection of information.

Some notes and tips on how to use this database

A couple of notes: the hospitals use different terminology to describe their services in some places. Because we didn’t know for sure that “Normal Vaginal Delivery of a Newborn – Mother’s Stay,” at H.C.A., is the same as “Vaginal delivery w/o complicating diagnoses,” at Banner Health, we left the hospitals’ original terminology. It’s confusing, but so is our health-care system.

Things to search for: vaginal delivery, C-section, tympanostomy (ear tubes), bunion, MRI, X-ray, colonoscopy, CAT scan, ultrasound, cataract removal, arthroscopy, endoscopy, blood transfusion, hernia repair. That should get you started.

If you type in a few letters, the search tool will offer you suggestions of what it thinks you’re seeking. If you find an item and it’s not in your state, try “all states,” the first location in the states list.

A bug we’re fixing: the search tool doesn’t always re-set to its original state after a search. So if you can’t get a result, try refreshing your browser window to start again.

For reasons having to do with database design, this hospital or big-ticket data is in a database separate from our other database, which has lower-cost items and procedures like walk-in clinic visits, MRI’s, Lasik and teeth cleaning.   So your searches for Lasik (on our front page search tool) must be separate from the searches for big-ticket hospital items like gall bladder operations and childbirth (on the hospital search tool). We’re working on making that better.

Want to help?

Here’s how to do it:

  • Contribute a lot of prices: Download or send your administrator this spreadsheet Download (XLS, 33KB).
  • Questions? Email us at: info@clearhealthcosts.com.