Access to Price Estimates for Hospital Procedures Still Lacking

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:

1. Create a national culture of price transparency
2. Federal and state governments should assist hospitals as they promote price transparency as a consumer right
3. Underlining the need for patients to value price transparency
4. Price transparency must start with hospital leaders
5. Hospitals should reevaluate current systems and improve their access to price estimates
6. Health systems should look for “one-stop shopping” rather than redirecting for pricing
7. Consumers should not be expected to know medical billing codes
8. Staff should be trained to provide more accurate, efficient, and friendly access to pricing
9. Clearer website navigation tools to price transparency