A skin biopsy at Lawrence Memorial Hospital goes for anywhere from $95 to $600. It all depends on who receives the bill. Removing a skin lesion, anywhere from about $120 to $920.
Now, because hospitals had to release millions of previously secret prices on Jan. 1, the public can see just how common price differences like these are.
Health care experts say the massive data dump — huge spreadsheets of headache-inducing medical jargon and arcane billing codes — will be difficult for people to translate into what they’d actually pay. You’d still need to understand copays and other factors.
“The vast majority of patients are not equipped to make use of this,” said Amanda Hunt, deputy director of the Healthcare Value Hub. “Consumers need to know what the cost of a service is to them.”
One saving grace: Hospitals had to put out more easily understandable, albeit much shorter price disclosures, to help the public look up hundreds of medical services. Some hospitals launched slick interactive tools. You put in your insurance information to find out the price under your health plan, and how much might come out of your pocket.
But the even bigger news, some say, flows from the potential that employers — armed with help from analysts who specialize in making sense of millions of data points — could mine the unprecedented trove of prices to press for better deals.
The American Hospital Association says the results could be “anticompetitive” once insurers and employers can see the rates that others get. Prices might even go up.
Health care researchers agree prices could rise in some situations. But overall they see potential for the transparency to help rein in eye-popping inflation.
“The information should be out there,” said Maanasa Kona, a professor at the Georgetown University Center on Health Insurance Reforms. “This transparency is an experiment worth undertaking.”
From 2003 to 2016, charges to employers rose nearly 75% for knee replacements and 135% for appendectomies, compared to broader economic inflation of about 30%, the Kaiser Family Foundation says. Higher prices, even when ostensibly footed largely by employers, ultimately hurt the little guy in the form of smaller paychecks or worse benefits.
Which prices became public on Jan. 1, and where can you find them?
Not all Kansas hospitals have complied with the Trump administration’s new price transparency rule. Some said they are working out the final kinks, all while dealing with a global pandemic that has hospitals understaffed and reeling.
Others didn’t respond to questions from the Kansas News Service about it.
But hospitals should release:
Spreadsheets that reveal prices for each service under each health plan in their network. That’s where you’ll see that a single hospital can negotiate a wide variety of prices with insurers for the same exact brain scan or hernia patch. You should also see cash discount prices. Knowing those could help if you don’t have insurance or want to sidestep your insurance to get that discount.
A more user-friendly price list or tool that helps patients see what the hospital would charge for at least 300 procedures.
A big caveat: All prices are estimates. Your situation can change. You could go in for a routine childbirth and end up having a C-section. The estimates also may not include a whole boatload of related fees.
If your hospital has posted the data, it can still be hard to find what you’re looking for.
“I looked around at a couple of hospital websites,” said Niall Brennan, CEO of the Health Care Cost Institute and former chief data officer for the Centers for Medicare and Medicaid Services. “I’m pretty data savvy and I was, like, ‘Jesus, this is hard.’”
Can you comparison shop?
“We’re a long way from achieving that goal,” Brennan said.
I ran price checks to see what giving birth costs at two different hospitals, because that’s a typical service that people have time to shop for in advance. Both websites got me quick answers that showed what I and my employer might expect to pay. (Specific to my insurance.)
LMH Health showed these options and prices:
“Vaginal delivery W O.R. proc except steril and/OR D&C” ($5,866, of which I might pay an estimated $1,036)
“Vaginal delivery W sterilization/With complications” ($6,636.21, of which I might pay $1,114)
“Vaginal delivery W/O sterilization/without complications” ($5,471, of which I might pay an estimated $997)
The University of Kansas Health System offered these:
“Inpatient obstetric care for vaginal delivery, including pre and post-delivery care” ($26,173, of which I might pay an estimated $1,696)
“Inpatient obstetric care for vaginal delivery after prior cesarean delivery including pre and post-delivery care” ($30,874, of which I might pay $1,843)
The descriptions and billing codes didn’t match. And KU’s estimate displays physician fees, while the LMH site says its estimates are “for hospital charges only and (do) not include any physician or other professional fees.” A patient would clearly have to call the hospitals for more information.
“It’s important to know clearly what is included and excluded in the price,” said Bill Kampine, cofounder of Healthcare Bluebook. But the explanations aren’t always clear. “Many of the sites that I’ve reviewed so far are a little inconsistent.”
He thinks this will get better.
How might employers end up using this data?
Kampine’s company, as implied by its Bluebook name, has spent more than a decade piecing together prices from medical claims and other sources to help employers peer into the black box and get more for their money.
The biggest boon from this month’s data dump could come when companies like his, as well as policymakers, academics and nonprofit groups start mining the massive spreadsheets.
The data could eventually feed into price tools like those created by Healthcare Bluebook or The Health Care Cost Institute. Researchers could uncover markets with unusually high prices, as RAND did in Indiana. Major employers and health plans could pressure the priciest hospitals to accept less for a hip replacement, as the California Public Employees’ Retirement System did. Employers could see when insurers aren’t getting them a good deal.
“Depending on which insurance policy you have,” Brennan said, “we are seeing five-, eight-, tenfold differences in prices.”
Medicare and Medicaid prices tend to be the bottom of the range. Prices charged to commercial insurers can be “sky high” he said, and vary a lot.
Insight will take time — assuming the prices remain public.
The American Hospital Association battled the Trump administration’s new rule in court, arguing that publishing prices wouldn’t help patients anyway. Billing is complex and so is health care. A surgery involves not just a surgeon, but many related expenses.
The group lost its court case, but it has called on the incoming Biden administration to ditch the requirement.