One health system is getting on the wave of health transparency and posting price estimates, although it still comes with barriers to patients shopping around for health services.
In Seattle, the Virginia Mason Medical Center is disclosing estimated prices for its 100 most common outpatient surgical procedures. The list, posted online for the public, covers everything from fine needle aspiration thyroid biopsies to cataract removal, and is meant to help guide patients who increasingly face high deductibles.
"Changes in health insurance plans often mean individuals are paying higher out-of-pocket costs for healthcare services," said Steve Schaefer, Virginia Mason's vice president of finance. "Understandably, they are looking ever more closely at cost and quality, and weighing those factors in their decision-making."
Virginia Mason's price estimation site, Schaefer said, is part of a "commitment to transparency and to providing information that helps individuals make informed choices about their healthcare."
Virginia Mason's move is a major step forward for patients, who can also access written estimate of their out-of-pocket costs for scheduled or planned inpatient and outpatient medical procedures. It's also a good initiative for Virginia Mason, a network 460 physicians, seven medical centers and a 336-bed urban hospital, able to boast of having some of most affordable hospital prices in the state. The health system has the lowest hospital prices by admission type in greater Seattle and prices 25 percent lower than the statewide average, according to a recent Washington Health Alliance study.
At the same time, patients looking for an exact price check on Virginia Mason's site have to do some additional investigation, considering facility fees and health plan variables and keeping in mind that it is an estimate.
"Your actual financial responsibility will likely vary greatly from the estimated price," Virginia Mason's price estimator notes. If your procedure is covered by insurance benefits, the insurance company will decide the amount you are responsible for paying.
"When the 100 procedures listed below and certain other outpatient services and procedures are performed in these hospital-based facilities, you (or your insurer) will be charged a hospital facility charge in addition to a professional (physician) charge." If those same services are received at one of Virginia Mason's outpatient clinics, the hospital facility fee won't be levied, but "other facility charges may apply."
Thus is the journey out of the Dark Ages of Healthcare Transparency: another layer of opacity and variation between the quoted price estimate and the eventual bill for the patient.
Still, Virginia Mason's move shows how healthcare organizations in progressive regions like the Puget Sound are pushing ahead to meet consumer demand, and it also suggests that health plans may have to contribute more to the price comparison effort.
Last year, the Everett Clinic became the Pacific Northwest's first health system to post prices online for its most frequently used procedures, from blood tests and advanced imaging to anticoagulation therapy and dialysis. The prices included self-pay rates, what would be charged without any adjustments by a health plan, and the 25 percent discount rate for prompt payment.
The provider-based moves are largely voluntary, as are some of the insurer-led pricing initiatives like Guroo, which shows cost estimates based on claims from Aetna, Humana and UnitedHealthcare, though not actual prices at providers that consumers could use to shop.
An open question that states and consumers advocates are mulling is whether transparency can be better regulated, either through mandated provider disclosures or payer disclosures in the form of claims databases.
In Washington State, despite its embrace of progressive health policies, lawmakers have considered creating what would be the nation's 14th all payer claims database, requiring health plans to disclose rates for hospitals and physicians as a way for researchers to track spending and consumers to have more information in selecting health plans and providers.
"I can shop for anything online, books and raisins, and know the price. The biggest battle we have in our area is the people who want to keep that secret," said Ron Sims, board chair of the state insurance exchange and former King County, Washington chief executive, describing the so far unsuccessful battle for the APCD. While state regulators, hospitals and consumer advocates supported the creation of the database, the state's largest insurer, Premera Blue Cross, argued that disclosing negotiated rates would not give consumers actionable information and would create new administrative burdens.