Can hospital pricing transparency help you make smarter healthcare decisions?

February 19, 2019 in Health Risk Management  •  By Miles Varn, MD
medical bills

There’s a new rule that requires hospitals to list the price for all the services they provide and medications they prescribe for patients in the hospital. In theory, this should give you more information that can help you figure out what your care will cost and where it makes the most economic sense to receive care. Unfortunately, that’s not how it turned out. While there’s a great deal of new information available, it can be difficult to find and nearly impossible for people outside the healthcare industry to understand.

The document that brings together this price information is called a chargemaster and it can contain tens of thousands of entries. The new rule doesn’t require that the information be written in plain language, only that it be machine readable, which means it’s in a format that a computer can process, so much of the data reads like it’s in a yet to be discovered language. For example, if you download Memorial Sloan Kettering’s chargemaster, you’ll find an Excel spreadsheet that contains 13,088 entries such as “CAP MALE/FEMALE RAIL, $765” and “BX SUBCUT SKIN/INC, $1,771”. Even if you are able to figure out the meaning of these abbreviations, the prices listed are different than the lower fees that insurers negotiate, so estimating how much you would actually pay for care is complicated at best and impossible at worst.

The goal of the hospital pricing transparency rule is to help patients understand the cost of their care and choose more wisely when deciding where to receive that care. Unfortunately, the information that is now available adds to the confusion and doesn’t help patients make one to one price comparisons when choosing where to receive care. And the rule only covers care delivered by a hospital, so patients don’t have the information they need to make price comparisons for services performed in doctor’s offices, urgent care facilities, diagnostic test sites, and outpatient surgical centers.

Better ways to get the information you need to make informed decisions about your care

Even though the new pricing transparency rule isn’t particularly helpful, there are still strategies and resources that can help you make more informed decisions about healthcare.

  • Seek a second opinion: Wrong diagnoses, inappropriate treatments (treatments that don’t meet the evidence-based standard of care), and medical errors can all lead to poorer health outcomes and drive up your healthcare costs. A second opinion from an experienced specialist can help you avoid those issues and can confirm or change your diagnosis, suggest other treatment options, and pinpoint misdiagnoses, especially in the case of serious and complex conditions like cancer, autoimmune disease, and back and joint problems. In fact, a Mayo Clinic study found that 88% of people who sought a second opinion from the hospital’s physicians for a complex medical condition received a new or refined diagnosis. Your health insurance plan may include a second opinion program or you can seek one online or with the help of a health advisor.
  • Make sure your care is coordinated: Duplicate testing and medical care is another way your healthcare dollars can be wasted. When communication between healthcare providers is inconsistent or medical records aren’t updated and shared with all the physicians you see, you may be at risk for repeat testing. Find out if your benefits plan offers care coordination through a case manager or health advisor to lower the risk of unneeded, repeat testing and prescriptions that can cause potentially dangerous interactions. Another key is the review and coordination of medical records, which is especially important if you see multiple physicians. Medical records management can include review of your records by an RN or physician, consolidation of a comprehensive medical record, and the creation of a secure electronic medical record that can be shared with all treating physicians. That can be especially important in an emergency or if you fall ill or are injured while traveling.
  • Choose the right place to receive care: While you can have a colonoscopy, medication infusion, or a range of common surgical procedures at a hospital, that may not always be the most appropriate or cost effective place to receive care. A care manager or advisor can explain the options for where you can receive the care you need (hospital, outpatient surgery center, doctor’s office). The right choice can have a big impact on your out of pocket costs.
  • Make sure your medical bills are accurate: Experts estimate that between 30% and 80% of medical bills contain errors that increase costs. There are many different causes of these errors, including the use of the incorrect billing codes and use of out of network healthcare providers. Find out if your benefits plan includes a medical billing review and negotiation firm or review your own bills to make sure what you’re being charged for is what you received.
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