June 01, 2018
By Carolyn Crist
(Reuters Health) - Although government measures and healthcare industry initiatives have tried to make prices more accessible to U.S. patients recently, researchers say there has been little improvement.
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.
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 Intern Med 2018.
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