Health care prices have sparked a huge debate in the United States.
So we at Clearhealthcosts.com and our partners at MedPage Today had a radical idea: what if we made the default mode in health care pricing transparency — instead of opacity? Here’s an editor’s note introducing the project by Peggy Peck, editor-in-chief at MedPage Today, and here is some of our coverage.
Price transparency: A Rosetta stone
By Robert Fogerty M.D.
I tossed and turned during many sleepless nights as a cancer patient. Some nights from nausea, some from pain. Some from sadness, some even from being cold without hair. …Nights fretting about the scan or blood work — had it spread? Would I see my graduation in 3 months? …
What many didn’t know, except for those closest to me, were the nights I stayed awake thinking about money. I distinctly remember one bill for $50,000. I was a college senior back in 2002, when doctors diagnosed me with metastatic testicular cancer. Where am I supposed to find $50,000? My job cleaning glassware in the chemistry department wasn’t going to cut it.
How will I get my treatment now that my insurance has been exhausted? What will this do to my family, will we have to go bankrupt? The financial sleepless nights were just as sleepless as the medical sleepless nights, and the concerns just as real. …
The financial worry never goes away; even when I see patients as a doctor, I worry about their financial burden. … We talk about their nausea, their pain, even their diarrhea and penile discharge, but for some reason, we don’t talk about their checkbook. It’s totally normal for me to walk into a room, ask someone to get naked and touch them all over, but God forbid I ask them about their financial status.
The whole thing is nuts. For the full story, click here.
Having insurance doesn’t always pay
By Jeanne Pinder
“I live in metro NY and received a bill for $2200 (approx) for a mammo/Ultrasound, of which approximately $767 was covered by insurance. I was balance billed $1,712,” the email said. “I am a 42 y.o. female physician with a family history of ovarian cancer, and I am covered by Blue Cross/Blue Shield. I was frankly horrified by the costs.” Of course we were interested: our research shows that a mammogram price can range from free (preventive, under the Affordable Care Act) up to $2,786.95. So … how much does a mammogram cost? The email came from Kimberly Greene-Liebowitz, MD, MPH, who works at CityMD, the New York area urgent care chain. A practicing doctor, and possessor of a master’s degree in public health, she found us when researching costs, and reached out with a sense of deep outrage. For the full story, click here.
Insurers’ payments vary more than hospital charges
By Jeanne Pinder
Reimbursement rates from payers are, of course, not available publicly in any easy or rational way. Sometimes you find out after the fact; some providers and insurers offer “transparency tools” but they are often wrong or hard to use. So the patient (or consumer, or individual) is often not able to know what the insurer will pay until after the fact. When we asked for providers to share prices, we were expecting that providers would send us cash or self-pay prices, and we have received several of those. But, interestingly, Sutter Maternity and Surgery Center of Santa Cruz for Peninsula Coastal Region Sutter Health, sent a spreadsheet with charged rates, reimbursement rates, and patient responsibility for a selected group of procedures at the hospital (see below). A sampling:
- Knee arthroscopy: Charges from $13,452 to $19,187; insurance payments from $2,681 to $13,607. Difference: a factor of 5-plus.
- Repair initial inguinal hernia (No. 1 and No. 2): Charges from $13,950 to $22,184; insurance payments from $2,515 to $12,281. Difference: a factor of almost 5.
- Colonoscopy and biopsy: Charges from $1,552 to $2,320; payments from $849 to $1,773. Difference: a factor of 2-plus.
- Carpal tunnel surgery: Charges from $9,694 to $11,721; payments from $1,953 to $7,079. Difference: A factor of 3.6.
For the full story, click here.
‘How Much Is That Going to Cost Me, Doc?’
By W. Ryan Neuhofel DO, MPH
Doctors get asked many difficult questions — “Did the biopsy show cancer?,” “Will I ever get better?” But, perhaps the scariest question a doctor can be asked is “How much is that going to cost me, doc?”
Throughout my medical education, the only real consideration of costs I witnessed was occasionally asking a patient, “Do you have good insurance coverage?” Financial issues may have been discussed with non-clinical office staff, but rarely were considered by providers with or without a patient present.
No matter how medically appropriate, many doctors’ recommendations go unfulfilled due to patient financial issues. Patients are not capable of answering, “Do I really need to have this test right now? or would it be okay to wait?” and if needed, “Is there a less expensive option that may also be appropriate?” Nobody is better equipped to answer these questions than physicians. For the full story, click here.
A new kind of partnership: ClearHealthCosts.com and MedPage Today
By Jeanne Pinder
Health costs are a blazing hot topic for debate in the U.S., as people feel the effects of rising co-insurance and rising deductibles, and the business of medicine goes through a series of wrenching changes.
MedPage Today has investigated the costs issue from just about every angle — from themillion dollar baby and million dollar ex-vice president to sudden insulin price spikes, lofty cancer drug costs, and the $300,000-a-year drug, all the way to why transparency is a physician’s friend.
Recently, news coverage by journalists like Elisabeth Rosenthal in the “Paying Till It Hurts” series in The New York Times and Steve Brill in his “Bitter Pill” coverage for Time magazine, have also explored the topic and offered some possible steps forward.
At Clearhealthcosts.com, we’re a journalism startup bringing transparency to the healthcare marketplace by telling people what stuff costs. We have noticed increasingly that patients and their providers are allied over the issue that money should not get in the way of treatment.
And so, we here at Clearhealthcosts.com and our partners at MedPage Today devised this partnership to develop that natural alliance. Joining hands together, we think, there’s a way to solve this problem. For the full story, click here.
Our partnerships, including the MedPage Today partnership
Health care prices have sparked a huge debate in the United States.
So we at Clearhealthcosts.com and our partners at MedPage Today had a radical idea: what if we made the default mode in health care pricing transparency — instead of opacity?
Go to this page to see our database of hospital prices. The front page of Clearhealthcosts.com also displays prices, with a search tool.
Clearhealthcosts.com has already partnered with public radio stations in San Francisco, Los Angeles, New York City and the Delaware Valley (Philadelphia) on similar efforts. Click the links for examples; our news coverage can be seen here and here.
Want to help? It’s easy. Send in your cash prices.
Here’s how to do it:
- Contribute a lot of prices: Download or send your administrator this spreadsheet Download (XLS, 33KB).
- Contribute individual prices in the form below.
- Questions? Email us at: info@clearhealthcosts.com or e.chu@medpagetoday.com.
Search the database. There are lots of prices already in the database: search “tympanostomy,” “vaginal delivery” or “gall bladder removal” for examples. Type a few letters for suggestions; to see many states, leave the “zip code” box blank.
