This summer, the Maine State Legislature enacted a law which empowers the consumer to gain information about the cost of various medical services offered by healthcare providers and organizations. The intent to this legislation was to make it easier for patients to find out what the cost of various services would be; however, I think it’s important for us to examine how successful has it been.
For starters, I can’t comment on or provided any detailed any statistical analysis, but I am more than willing to share my own experience as well as that of my family. l would like to start by giving you a sense of how two different conversations should go and how they went:
Me: “I’d like to find out how much an office visit for an annual physical costs”
Representative: “sure, may I ask you a few questions for clarification?”
Me: “of course”
Representative: “great. First of all, how old are you? Are you male or female? Have you been seen at our practice before? So you think you will need any lab tests done such as your cholesterol?”
Me: “well, last I checked, I’m male. I’m not as young as I used to be, so let’s just say, I’m over 40. No, I haven’t been seen at your practice and I’m fairly certain I will need to have my cholesterol checked.”
Representative: “excellent. The estimated cost of a new patient physical for a male over 40 is $ XXX.XX. This cost does not include things like lab tests, so if you need to have some lab tests done, a cholesterol panel costs $ XX for example, and a metabolic panel to check for things like diabetes and kidney disease costs $ XX.XX. There may be other tests that the doctor may recommend and we are happy to provide you an estimate of those tests once you find out what your doctor is recommending. Is there anything else I can help you with today?”
Caller: “hello, I need to schedule a screening mammogram, can you provide me an estimate of the cost?”
Representative: “certainly, thanks so much for calling us and allowing us to participate in your care. Screening mammogram generally cost $ XXX.XX. There may be some additional costs if the radiologist feels that more pictures are necessary or if the radiologist recommends an ultrasound, so a rough estimate is that the additional views would cost $ XXX.XX and a usual ultrasound costs $ XXX.XX. Do you have any other questions I can help with today?”
Caller: “nope, I think that does it. Thanks so much!”
Fairly straight-forward question and answer, wouldn’t you agree? Well, here’s how things really went:
Conversation #1 (the abridged version)
Earlier this year, I called a local healthcare organization to find out what the cost of an annual physical would be as I don’t carry insurance and any healthcare costs are out of my own pocket. I wanted to be sure that I could afford the visit and would be able to pay for it when the service was provided. It took me 6 months…yes, 6 months…to find out what the cost would be – that was after making a dozen phone calls and speaking with representatives from multiple departments. After about 4 months, I received a price listing for the “most common procedures”; however, nowhere on the list was the price for an annual physical! It took another 2 months and pulling “favors” with colleagues within the organization to finally find out what the cost of the service was. Absolutely ridiculous.
Conversation #2 (again, the abridged version)
A family member contacted me to find out what the “code” was for a mammogram (meaning the CPT or common procedural code…a 5-digit number billing services use to identify the service provided). She was due for her mammogram and, wanting to be a smart shopper, needed the code in order to find out what the cost would be. Why she needed the code is another issue, but nonetheless, I provided her the codes associated with mammograms, specifically those codes assigned to “screening mammogram”, the test she needed. She then used that code and called 3 healthcare organizations (2 locally and 1 in the southern part of the State) expecting that, as she had “the code”, it would be easy to find out what a “screening mammogram” would cost. Guess what? Crickets. Not a single representative could provide her with a cost estimate. She spent several months making multiple calls to eventually find out how much a mammogram would cost. Another ridiculous situation.
So, what’s the solution? We certainly don’t need more legislation or a government agency providing oversight, but what we do need to take some very simple steps. Recognizing that low-cost does not necessarily reflect quality, the published cost of healthcare services needs to be viewed in the context of who is providing the service. This is no different than any other industry or service. The adage, “you get what you pay for” rings true in healthcare just as much as it does when purchasing any other product or service. Having said that, here is a simple solution to make transparency more effective and understandable:
Any healthcare organization can run a report of their most common services. It’s as simple as running a report in their accounting or billing software. Take the “top 10” list, if you will (although the law requires publishing information for any service performed more than 50 times in the preceding year), and simply publish the data on the company website. This way, it’s consistently clear. The organization or company doesn’t have to worry about whether or not everyone in every department intimately knows what the “top 10” list is or the accompanying prices. For an office such as mine, this has worked out well. When prospective, or current, patients ask about the price, I, and my staff, simply direct them to our price listing. In fact, we have printed copies of this price list in the office (which have been unanimously well received!).
Granted, it would be possible to provide a price estimate for a complicated surgical case; however, here are some common items that every physician office, laboratory and radiology center (whether privately owned or part of a healthcare organization) can provide an estimate for.
For physician offices (whether private practice or hospital based):
- cost of an annual physical
- cost of a routine office visit
- cost of a new patient visit
- cost of a well child examination
- cost of a minor surgical procedure such as repairing a laceration
- cost of a cholesterol panel
- cost of a comprehensive metabolic profile (electrolyte, liver and kidney test)
- cost of a thyroid test
- cost of a urinalysis
- cost of a complete blood count
For radiology centers:
- cost of a chest x-ray
- cost of a screening mammogram
- cost of a breast ultrasound if needed with a mammogram
11/13/2014 Update: Just came across this site which provides some data about the cost of services