Price Transparency Debated
MyHealthGuide Source: Melanie Evans, 2/25/2015, Modern Healthcare Article
Healthcare consumers have a new tool to compare prices using data from some of the largest U.S. health insurers, but comparison shopping will remain a challenge for most. The Health Care Cost Institute, a not-for-profit healthcare research organization, launched the first of two websites conceived to help consumers navigate prices for medical services.
The website, Guroo, allows consumers to search for average prices for 70 services across more than 300 hundred cities, 41 states, coastal California and the District of Columbia.
Example: Enter "Gallbladder" in Guroo
Below are excerpts from the website.
Gallbladder Removal - Laparoscopic
Laparoscopic gallbladder removal is surgery to remove the gallbladder using a medical device called a laparoscope.
Cholecystectomy - laparoscopic
- Cost Overview
- National Average$15,771
IN YOUR AREA:
Tennessee State Average $14,099
Nashville, Tennessee Average $18,367
- National Average$15,771
- Care Detail
- What to Expect
- Questions to Ask Your Provider
- How to Prepare
- Related Links
Surgery using a laparoscope is the most common way to remove the gallbladder. A laparoscope is a thin, lighted tube that lets the doctor see inside your belly.
Gallbladder removal surgery is done while you are under general anesthesia so you will be asleep and pain-free.
The surgeon will make three to four small cuts in your belly. The laparoscope will be inserted through one of the cuts. Other medical instruments will be inserted through the other cuts. Gas will be pumped into your belly to expand the space. This gives the surgeon more room to work.
The gallbladder is then removed using the laparoscope.
An x-ray called a cholangiogram may be done during your surgery.
To do this test, dye is injected into your common bile duct and an x-ray picture is taken. The dye helps find stones that may be outside your gallbladder. If other stones are found, the surgeon may remove them with a special instrument.
Sometimes the surgeon cannot safely take out the gallbladder using a laparoscope. In this case, the surgeon will use open surgery, in which a larger cut is made.
Why the Procedure Is Performed
- You may need gallbladder removal surgery if you have pain or other symptoms from gallstones.
- You may also need it if your gallbladder is not working normally.
Common symptoms may include
- Indigestion Pain after eating, usually in the upper right or upper middle area of your belly (epigastric pain)Nausea and vomiting
- Most people have a quicker recovery and fewer problems from surgery through a laparoscope than with open surgery.
- The risks for any anesthesia include: Reactions to drugs you are given, Breathing problems, Pneumonia, Heart problems, Blood clots in the legs or lungs
- The risks for gallbladder surgery include: Bleeding Damage to the blood vessels that go to the liver Infection in your belly Injury to the common bile duct Injury to the small intestine, Pancreatitis (inflammation in the pancreas)
Before the Procedure
- You may have the following tests done before your surgery:
- Blood tests (complete blood count, electrolytes, and kidney tests)Chest x-ray or electrocardiogram (EKG), for some people Several x-rays of the gallbladder
Prices are drawn from medical claims for 40 million Americans covered by Aetna, Assurant Health, Humana and UnitedHealthcare.
Consumers will be able to identify the low, average and high prices within each market, and they will see prices for all of the services to treat certain conditions, including office visits, laboratory and diagnostic tests, and other services in addition to the procedures themselves.
"HCCI is going to use this data to ultimately create a national source of truth for consumers," said Tom Beauregard, executive vice president of UnitedHealth Group.
The new website comes amid a wave of healthcare price transparency tools developed by entrepreneurs, health insurers and states to give patients and employers more ability to shop around. Pricing tool Castlight Health went public roughly one year ago with a hugely successful initial public offering. (Wall Street has lost some of its enthusiasm recently, although the company has been adding customers and narrowing its losses.) A dozen states operate all-payer claims databases. Regulators, too, may use price data to challenge hospitals and doctors to justify wide differences in price.
Price Transparency Debated
But useful price information for consumers and regulators remains out of reach in many areas of the country. "There's still a big distance between what you experience as an individual and the price you might have to pay and what ends up being disclosed," said Francois de Brantes, executive director of the Health Care Incentives Improvement Institute. State data is often difficult for consumers to access and understand.
For the new website, the Health Care Cost Institute selected conditions for which patients can plan ahead. "We focused on shoppable, discretionary, scheduled services," said David Newman, HCCI executive director.
The prices do not yet include the cost of pharmaceuticals, and the website does not include data on quality, but officials said measures of quality are under development.
Average prices will give consumers a reference point to help them compare prices as they shop. Guroo prices are accurate "assuming that the patient, on average, is average," he said.
But that is rarely the case, de Brantes said. That's because illness and medical care are highly complex. To better prepare patients for differences and sticker shock, public pricing should clearly disclose what services are included -- and excluded -- from estimated medical bills.
"Let's be clear about what's in and what's out and how that might affect the price I have to pay for that particular condition, illness or injury," de Brantes said. "Healthcare is complex and people aren't stupid. Explain what you're doing. Be clear about it."
Patients who will benefit most from public prices are those who remain uninsured despite the Affordable Care Act'sexpansion of subsidized health plans or those with extremely high deductibles who face significant expenses for everything but the most routine preventive care.
Some experts also suggest that price transparency can help slow healthcare inflation and the overall cost of healthcare, though price growth has recently been weak.
Mark Pauly, a health policy and management professor at the University of Pennsylvania, said comparison shopping among such a small percentage of the nation's patients will do little to slow the overall growth in U.S. healthcare.
But employers and regulators can use published prices to exert pressure on providers to lower or justify their rates, as has been the case in Massachusetts and New Hampshire, said Chapin White, an economist and senior policy researcher for RAND Corp. who studies price transparency.
Later this year, patients with health plans from insurers involved in the effort will have access to a separate website developed by the Health Care Cost Institute that will provide personal information on consumers' out-of-pocket costs.