Shopping for health care coming to hospitals near you

May 29, 2013 

The next time you visit your doctor or other health-care professional, try this experiment: Ask how much that day’s visit cost. If you are about to have a procedure, ask the same question about the procedure’s cost. The most likely answer is, “We don’t know,” or “It depends.” Due to the plethora of insurance plans and Medicare and Medicaid reimbursements, the office probably doesn’t know the cost and won’t find out until the bill is issued and sent on for payment. The reimbursement amount may differ greatly from the billed amount.

A story in Saturday’s Telegraph exposed Medicare billing disparities that should concern everyone. Area hospitals charged vastly different prices for like procedures according to Medicare billing data.

In a graphic comparing how many times 13 area hospitals had the highest and lowest price, more times than not, public hospitals had the lowest prices for procedures and for-profit hospitals the highest. For example, the treatment for pneumonia and pleurisy with major complications ranged from a low of $11,674 to a high of $44,300. For treatment of septicemia, a low of $16,561 to a high of $56,273.

While the billing data is a sticker price hardly anyone pays, due to negotiated rates by Medicare, Medicaid and insurance companies, the information is important and will become more so as we move into the next era of health care where a hospital’s infection rates, readmission, mortality and patient satisfaction data is on the Internet for all to see (www.medicare.gov/hospitalcompare).

Soon we may also have extensive information on doctor success and failure rates. What is plain is that patients have far less information than they need to make an informed consumer choice, a necessary function if we are to get a handle on health-care costs. The data on hospitals is just the beginning to help patients ask the right questions and get the right answers.

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