A survey of 54 hospitals from 6 major metropolitan areas found that consumers are still encountering difficulties when trying to obtain price estimates for routine hospital procedures.
A recent Pioneer Institute survey revealed that in spite of Affordable Care Act (ACA) provisions, CMS guidelines on how to enact these provisions, and federal and state laws regarding price transparency, consumers may still encounter difficulties when trying to obtain price estimates for routine hospital procedures.
The purpose of the study was 2-fold: determine how easy or difficult it is for the average consumer to access healthcare price information and if the price information received was accurate.
Researchers led by Barbara Anthony and Scott Haller surveyed 54 hospitals from 6 major metropolitan areas with high populations of uninsured individuals: Des Moines, Iowa; Raleigh/Durham, North Carolina; Orlando, Florida; Dallas, Texas; New York, New York; and Los Angeles, California.
Callers asked the hospitals about a complete price estimate for a magnetic resonance imaging (MRI) scan of the knee, which would include the price of the scan and the price of the radiologist’s reading. Callers also reported that they were self-pay, meaning that they either had no insurance, were shopping out of network, or merely wanted to know the price of a routine procedure; as self-pay they would also be eligible for specific discounts.
Of the hospitals surveyed, 57% took more than 15 minutes to provide the complete price. For more than half of the calls, the researchers were told to call another organization in order to obtain the radiologist reading fee; in some instances, callers had to request this fee because it was not offered in the estimate.
Callers experienced long holds, multiple transfers, multiple dropped calls, or had to call multiple times. In some cases, the callers were asked to provide medical billing codes of which an average consumer would not have any knowledge. Callers spent the least amount of time on the phone with hospitals in the Raleigh/Durham area and spent the most amount of time on the phone with Orlando hospitals.
Of the 54 hospitals, 14 could not provide a complete estimate and the researchers had to forego any more calls to these locations. MRI price estimates ranged from $400 (Huntington Hospital, Los Angeles) to $4544 (Montefiore Medical Center, New York). New York City had the most price variation of any area. The survey could not determine any reason for price variations throughout the metropolitan areas.
“Although there were several hospitals where we could not locate any information at all about obtaining price estimates for procedures, the majority of hospitals surveyed had some information about obtaining estimates, even if they were not very consumer friendly…. Some hospitals instructed consumers to call but did not provide a specific phone number,” the authors reported. “A few gave a phone number and included an online estimate request form on their websites.”
Of the 54 hospitals, 18 were able to give the complete price of the procedure without sending callers to a second party.
There have been previous studies indicating that consumers are uninterested in price comparison, but there has been evidence that two-thirds of consumers with deductibles between $500 and $3000 and three-fourths of those with deductibles over $3000 have tried to access price information, according to the report.
“The fact that there are people with high-deductible health plans who are foregoing care rather than value shopping has led some to conclude that consumers aren’t interested in price data,” Pioneer Institute Executive Director Jim Stergios said in a statement. “But the real issue is that price information isn’t readily available in the healthcare marketplace.”
Americans with private insurance are paying more than ever due to high-deductible insurance plans, which increases the need for price transparency for consumers. Anthony and Haller suggested several recommendations to promote price transparency:
Perioperative Nivolumab Boosts NSCLC Survival: CheckMate 77T Trial
May 16th 2024This interim analysis of the CheckMate 77T trial, outcomes were compared between adult patients receiving neoadjuvant nivolumab plus chemotherapy or neoadjuvant chemotherapy plus placebo for resectable non–small cell lung cancer (NSCLC).
Read More
Decitabine, Venetoclax Combo Boosts Survival in Patients With AML and MDS
May 16th 2024Study findings demonstrate that combining decitabine with venetoclax enhances molecular response rates in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), correlating strongly with improved clinical outcomes and overall survival.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Atypical Marker Expression in T-Cell Acute Lymphoblastic Leukemia/Lymphoma
May 15th 2024Two unique case reports highlight the diagnostic challenges and critical importance of comprehensive immunophenotyping in cases of T-cell acute lymphoblastic leukemia/lymphoma that present without typical immaturity markers but with rare γδ T-cell receptor expression.
Read More
After the ACA Expanded Health Care Access, 2024 Elections May See Voters Demand Affordability
May 15th 2024At the spring conference of the New Jersey Health Care Quality Institute, speakers discussed how health policy, affordability, and transparency may play a role in voters’ decisions.
Read More