A regional health system in the Pacific Northwest is taking a major step towards price transparency, but there are still caveats for patients managing their own healthcare costs.
Seattle’s Virginia Mason Medical Center is now disclosing estimated prices for its 100 most common outpatient surgical procedures, and posting it for the public online.
The list covers everything from fine needle aspiration thyroid biopsies to cataract removal, and comes as more patients find themselves acting as healthcare consumers — left with little choice but to shop around if they want to avoid a huge bill.
“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.”
The new 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.”
[See also: Creating hospital price transparency is easier said than done.]
In many ways, Virginia Mason has much to gain from offering the price disclosures. It’s a benefit for patients, who can also access written estimate of their out-of-pocket costs for scheduled or planned inpatient and outpatient medical procedures.
And Virginia Mason, with 460 physicians, seven medical centers and a 336-bed urban hospital, can lay claim to having some of the lowest 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, the nature of healthcare reimbursement and insurance currently means that patients looking for an exact price check on Virginia Mason’s site have to do some additional investigation — about what kind of facility they’re visiting and their health plan details.
“Your actual financial responsibility will likely vary greatly from the estimated price,” Virginia Mason’s price estimator notes.
“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, although “other facility charges may apply.” And, the disclosure notes, “the insurance company will decide the amount you are responsible for paying.”
Thus are the challenges for health systems trying to meet demand from consumers on high deductible plans — a price estimate if not a guaranteed price. Still, healthcare organizations in progressive regions like the Puget Sound are pushing ahead.
[See also: Healthcare price transparency becomes reality in Massachusetts.]
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 show the self-pay rates, what would be charged without any adjustments by a health plan, as well as the 25 percent discount rate for prompt payment.
However, healthcare providers, payers and regulators in Washington State are, as elsewhere, still not in total agreement about the best ways to bring consumers transparency.
“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, in a presentation at the Maine Health Management Coalition last year.
Sims was describing the failed efforts to create what would have been the nation’s 14th all payer claims database, requiring Washington insurers to disclose and publicize their rates for hospitals and physicians. 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.