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 In a follow-up to a 2011 study, researchers canvassed hospitals and
surgeons trying to get price quotes for a full hip-replacement
surgery. In less than half of cases, they got a complete or partial
price for the procedure - and the number of hospitals that could
provide any price information dropped from 48 percent to 21 percent
from the first study to the second one.
"Prices can be daunting, and patients often go into procedures not
understanding what the total cost may be and what they will pay,"
said lead author Safiyyah Mahomed, a medical student at the
University of Toronto.
Most states require hospitals to report price information, she and
her colleagues write in JAMA Internal Medicine, and in 2012 there
were at least 60 state healthcare price transparency websites. In
2014, the Government Accounting Office called on the Centers for
Medicare and Medicaid Services to make pricing information
available.
"We wanted to check in and see if anything had changed during the
push to increase price transparency," Mahomed said in a telephone
interview. "Did that make a difference in terms of patients' ability
to get information?"
The researchers had contacted 122 U.S. hospitals in 2011 for price
information for total hip arthroplasty, including 20 top-ranked
orthopedic hospitals and an additional 102 randomly selected
hospitals in every state and the District of Columbia.
In 2016, the researchers called 120 of the same hospitals, posing as
a granddaughter seeking information about the price of a hip
replacement for her 62-year-old grandmother. They asked for the
lowest "cash" bundled price, which would include all hospital and
doctor fees. If the hospital was only able to provide the hospital
fee, they asked for the name of an orthopedic surgery practice they
could call for the doctor fee. Each hospital was contacted up to
five times. Prices were categorized as hospital price only, doctor
price only, a bundled price for both as provided by the hospital, or
a complete price obtained by combining hospital and doctor quotes.
The research team obtained a bundled price from eight hospitals, a
complete price from 25 by contacting the hospital and doctor's
office separately, a partial price from 34 hospitals and no price
from 53 hospitals.
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The proportion of hospitals able to provide a bundled price fell
from about 16 percent in 2011 to about 7 percent in 2016. In
addition, the proportion unable to provide any price rose from 14
percent to 44 percent.
Prices had not changed much. The average bundled price was $44,300
in 2011 and $37,900 in 2016. When researchers could only get the
hospital's portion of the price, the figure was $33,277 in 2011 and
$35,105 in 2016. Physician-only prices averaged $6,584 in 2011 and
$6,988 in 2016.
"Patients need to know that the prices are there, but it takes
effort, for better or worse," Mahomed said.
"Patients want to know more about their cost information, and we as
a healthcare system aren't meeting that need," said Anna Sinaiko of
the Harvard T. H. Chan School of Public Health in Boston, who wrote
an accompanying commentary.
"Transparency is important because it makes it harder for providers
to charge higher prices without providing higher quality," she told
Reuters Health in a telephone interview.
But hospitals and doctors might not have all the information needed
to give price estimates because they might not know the doctor's fee
or the cost of specific tests, Sinaiko noted.
Instead, price data published by a neutral third party based on
information from paid healthcare claims from multiple payers and
clinicians could better show if price transparency has changed, she
said.
Price transparency initiatives could also include more than patients
since doctors often "buy" healthcare services on behalf of patients
when ordering tests and procedures, making referrals or prescribing
drugs, she added. Incentives should encourage doctors to choose
lower-priced and higher-value care, as well as talk to patients
about these costs.
"Shopping for healthcare services is different than shopping for any
other good in important ways," she said. "Standardized definitions
of care could allow for apples-to-apples comparison of prices."
SOURCE: https://bit.ly/2smPic0 and https://bit.ly/2sAXtRp JAMA
Internal Medicine, online May 29, 2018.
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