As consumers, we routinely compare prices online for various types of products and services, whether it’s a pair of shoes, a car, a hotel room, or a flight to or from Washington D.C or West Virginia. However, up until now (and some argue even now) it has been difficult if not impossible to find prices online for medical procedures such as x-rays, knee replacements, heart surgeries, colonoscopies, blood tests, or literally hundreds of other medical services.
At the beginning of this year, every hospital in the country is now required to list its standard charges on its website for every service and product it offers. These lists can literally include tens of thousands of line items due to the vast quantity of individual procedures and items hospitals offer to patients.
The rule specifically requires hospitals to update these prices on their website at least once per year and to also provide the information in a “machine readable format” which allows consumers to download and digest the data in spreadsheet form. This information is commonly referred to as chargemaster data in the medical/health care industry.
Why chargemaster data may be of little practical use
Although this forced transparency with price lists may seem like a huge step forward for consumers, Dr. Natalie Azar, NBC News medical contributor, describes potential confusion that this information in the form it is being provided may cause consumers: “The concern is that there’s a big difference between what the list price is and what the actual transaction price is — the cost the patient is responsible for.”
As Azar notes, the list price posted by a hospitals for a particular procedure may not have practical meaning for patients due to the fact that patients still have to find out from their insurance company the actual price they will pay – referred to as the patient responsibility, or bottom line.
In addition, in order to achieve a system that allows smart consumer comparison shopping, the ill or injured patient would need to evaluate a long list of the various components of the medical care they would receive. Theoretically, from this list the consumer could review the price roster of these components one by one and total up the charges.
However, even if this information is provided, the consumer would still be unable to obtain a reasonably accurate price estimate. This is due to the fact that the listed prices do not include any deductions or discounts obtained by the insurance company from a particular hospital and the doctors practicing within the facility.
At times, employers can also work out deals with medical providers for reduced procedure costs which are not reflected on these price lists. Another factor that complicates the issue is the patient’s health coverage deductible and whether this deductible has been met or if the hospital’s insurance company will pay for its charges at the in-network or out-of-network cost.
Another factor that can affect the actual cost to the consumer is the fact that hospitals are free to charge different prices for services and medicines based on the location of a particular facility and the type of patients (in terms of financial capacity) that facility is likely to see.
Another difficulty for consumers is that each hospital institution may list different abbreviations, acronyms, and procedure names and descriptions for the same service, making accurate comparisons impractical.
Difficulty finding hospital price lists
The level of difficulty in finding price lists varies widely from hospital to hospital. For instance, downloading a price list from George Washington Hospital’s website is fairly easy. Simply click the Patients & Visitors Tab, click Standard Services, check off several boxes and quickly gain access to a spreadsheet downloadable document of nearly 5,000 individual prices. The same goes for INOVA that serves Northern Virginia. Their price list document is easily accessible under their website’s Patients and Visitors Tab in spreadsheet format and consists of more than 13,200 individual prices.
However, the experience is more arduous when seeking price lists for other hospitals, according to a website survey done by Quartz. Excessive time clicking through pages in some cases to locate lists and in other cases, not finding the lists, or finding them only through a direct Google search comprised some of the difficulties involved.
No real help for emergency patients
People facing an emergency health situation – for instance, from a sudden personal injury – will not find much help from these price lists as they are being rushed to the ER. The best the public may be able to do currently is remain aware of general prices for common medical procedures in advance and also consider the quality of care and safety record of particular local hospitals if and when the need to use their services arises.