In Health Care, Price Transparency Varies By State

Sep 18, 2014

The All-Payer Claims Database Council--one of the organizations Denise Love works with--tracks which states have developed or are working on APCDs.
Credit All-Payer Claims Database Council / www.apcdcouncil.org/state/map

Richard Coll isn’t exactly racing out the door to get a colonoscopy, but at 63-years-old, he knows he shouldn’t put it off any longer. One thing stands in the way, though: getting a price for the procedure, up front.

“Shopping around, and everyone I asked, whether it was the doctor or an institution like a hospital, they looked at me like I was crazy,” says Coll.

He lives in Manchester, New Hampshire, where he makes his living as a self-employed property manager. The job awards him flexibility, but not health coverage.

“I haven’t had insurance since 1987 when it skyrocketed to about $3,500 a year from $2,400 a year. So those are funny numbers today, I suppose,” he says.

Coll and his wife pay out-of-pocket for their care when something urgent comes up, while letting other things slide, including that much overdue colonoscopy.

Coll says he always prices out construction materials before purchasing. Why couldn’t he do the same with his health care?

A RESOURCE UNDER THE RADAR

Well, in New Hampshire, unlike in Florida, you can. There’s a website, nhhealthcost.org, that for the last seven years has listed every hospital’s price for about 30 common procedures.

Crucially, the site lists the actual prices for services including mammograms, MRIs, hernia repair and colonoscopies -- not just what the hospital charges. For people with private insurance plans, the site also details expected out-of-pocket expenses.

The problem is that not many people know about the online tool.

“We have not marketed it, we haven’t done any outreach,” says Tyler Brannen, health policy analyst with New Hampshire’s Insurance Department, which manages the site.

But Brannen hopes that will change in the future.

“The world is a bit different now than it was in 2006 or '7, and these data are a lot more important to a greater number of people."

AN UNEXPECTED IMPACT

The technical name for this collection of prices is an all-payer claims database. More than a dozen states are in various stages of building one.

But New Hampshire was the first with a user-friendly website, making it something of a laboratory for health policy researchers, including Ha Tu with Mathematica Policy Research. She’s studied the New Hampshire experiment, and found it has made a modest impact.

“The prices from the high price hospitals did shift. Not, perhaps, as a direct result of consumers voting with their feet,” says Tu.

Instead of consumers using the website to shop around, the insurance industry took advantage of the sunshine and pressured hospitals that were charging the most.

Insurers now had leverage over these facilities, and in at least one high-profile example, were able to force a hospital to lower its rates.

Additionally, Tu says some of New Hampshire’s large public employers started using the information in their own negotiations with medical providers.

FLORIDA'S STALLED EFFORT

New Hampshire, due to its small geographic size and terrain, has limited hospital competition and only a handful of insurers. Other states, including Florida, could see different results from a public all-payer claims database.

But Denise Love with the National Association of Health Data Organizations says not all politicians -- locally, and across the country -- are willing to pay the upfront costs.

“Money is tight, so funding is probably the greatest obstacle,” says Love.

Florida’s Agency For Health Care Administration asked for $5 million in the last budget cycle to finance a claims database. The request was denied.

Love says whatever the price tag, it’s a small expense for greater transparency.

“And that is an important thing for state policy makers, but also for the industry, and hopefully, for the consumers,” she says.

Including consumers like Richard Coll, who kept putting off that colonoscopy because no one could give him a price. Finally, one local hospital did.

“After 50 you are supposed to get it done, so I've been asking about since I was 50, I’m 63 years now. I finally got it done,” says Coll.

He got a clean bill of health, and his bill for the procedure was the price they quoted him: $2,000.

Consumers Face Range Of Prices At New Hampshire Hospitals | Create Infographics

See all our Power of Price coverage at WLRN.org/price and see the Miami Herald's Power of Price series here.