Massachusetts Launches Health Care Shopping Experiment
To shop for health care, it would help to know what childbirth or a CT scan will cost ahead of time. But is it possible to actually list prices for medical procedures? And will patients armed with the information look for bargains when they seek care?
Massachusetts is trying to find out. Since Jan. 1, hospitals and doctors there have been required to tell patients how much things cost, if they ask. It's part of the state's health care cost control law. We set out to run a test.
Our shopper: Caroline Collins, a 32-year-old pregnant real estate agent from Fitchburg who is trying to compare prices for a vaginal delivery. Her first call is to the main number at Health Alliance Hospital in nearby Leominster. From there, she is transferred to the hospital's obstetrics department. A receptionist there tells Collins to call the billing office at UMass Memorial Medical Center in Worcester, which is part of the same hospital network as Health Alliance.
When a customer service rep answers, Collins launches right in: "I'm due in June and my husband and I have pretty minimal coverage, just a really high deductible, so I just wanted to check and see what the cost would be." Collins' deductible is $3,000 a year, but she expects the delivery to cost more than that. She just wants to know how much more.
Collins is directed to the extension of someone named Cathy, who apparently has the price list for services at UMass member hospitals. Turns out Cathy will be out for two weeks. Collins leaves a message, tries another number in the billing office and leaves another message.
She moves on to Emerson Hospital, where she's transferred from the main switchboard four times before leaving a message for a woman who has not called back after two days. Massachusetts law requires a callback within two days.
The only place where she reaches a person who gives her a price after one call is a natural birth center called the Birth Cottage. Their price: $3,000 to $5,000 for a normal vaginal delivery.
The third day, Collins hears from UMass Memorial. "She did give me an average price," Collins says. A vaginal delivery would cost "between $10,000 and $16,000." If her delivery turned into an emergency C-section, the cost would be between $20,000 and $30,000 "depending on the operation and how it went," Collins says.
Collins is told she will probably only have to pay her $3,000 deductible of whatever the price is in the end, but she's not sure. She's getting conflicting information about what is and isn't covered from her obstetrician, the hospitals and her insurer.
No one said this would be easy. Each hospital negotiates prices with each insurer. Sometimes the hospital and physician charges are separate, sometimes they are not. And what the patient pays on top of their premium varies if they have a deductible or coinsurance.
"The main thing I wanted to find out was whether I would have any surprises," Collins says. "I kind of wanted to be prepared for that. It sounds like I will be OK, but you never know until it's over, so I guess I'll find out."
"The experience was pretty frustrating from beginning to end," she adds. "It was definitely surprising how many machines I spoke to within the last few days."
Both Emerson Hospital and UMass Memorial Health Care say they are committed to making prices easily available for patients. A spokeswoman for Emerson says she was dismayed that Collins did not receive a prompt response.
Robert Brogna, a spokesman for UMass Memorial, says the hospital is "working through some challenges in the early days of the new requirements, and some interactions have clearly been less than optimal. This will change. In the coming weeks we will be providing a phone line and establishing new policies and procedures to support this new requirement."
"It's very different from, you go into Best Buy, you want to buy a refrigerator," says Karen Granoff, the senior director for managed care at the Massachusetts Hospital Association. Granoff says her members are working with insurers to nail down prices that hospitals can quote patients.
"They know they need to do this," Granoff says. "They are not opposed to the transparency. I think they are worried about the challenge of getting the information to the patient."
There's no enforcement mechanism in the law to make sure that hospitals and doctors are complying. But the state's undersecretary for the Office of Consumer Affairs, Barbara Anthony, says the time has come to put price tags on health care.
"It's kind of, ridiculous, is the word that comes to mind, that we're actually talking about the pros and cons of whether consumers should know how much their health care costs," Anthony says. "I mean what other commodity or service do we ever debate whether or not a consumer should know the price of a service before purchasing? You can't even name one."
This story is part of a collaboration among NPR, WBUR and Kaiser Health News.
Copyright 2014 WBUR