What does a knee replacement cost? Hospital price transparency could lead to better quality, lower prices
You may not do a lot of shopping around when you need a joint replacement or full-body PET scan, but now an estimate of charges should be online at every hospital, according to the federal Centers for Medicare and Medicaid Services.
That’s the rule from CMS.
Lincoln’s two hospital systems — Bryan Health and CHI — have their own price estimators available online. Bryan also has the government version of a “machine readable,” albeit not so user-friendly, list of charges.
On the CHI St. Elizabeth website, that hospital’s cost estimator link is at the bottom of the front page. The required CMS listing of charges could not be found.
Bryan’s price estimator and government listing is about five clicks in, starting on “Patients and Visitors,” then “Pricing, insurance, billing and financial assistance,” “Price estimates,” an explanation and then “Online price estimator.”
The government’s listing, that was to go up Jan. 1, is found under “Procedures, supplies, medications, miscellaneous.”
In that format, said Bryan spokesman Brad Collee, it’s able to be tracked by procedure code and does not appear to be as much for consumers. It mostly allows the government to gather data, and to compare pricing at hospitals, he said.
Using the hospitals’ own price estimators, which have a lot of caveats, the St. Elizabeth cost for a knee replacement is listed in a range from $32,005 to $55,426, with a median cost of $42,932.
With Bryan’s estimator, that median cost is $41,298, both without any negotiated discounts from insurance providers.
A full-body PET scan would be $6,512 at CHI St. Elizabeth and $6,421 at Bryan, before any discounts.
Inserting a pacemaker would cost $9,500 at CHI.
A heart catheterization would be $13,600 at Bryan.
Again, it’s not as simple as one number; there are a lot of considerations. But you’ll get a basic idea.
“They’re going to see probably a really big number on (the price estimator),” Collee said. “We hope that doesn’t discourage people. ... ”
Almost all of the time, people won’t be paying that price, he said.
Those prices don’t include insurance discounts, and they don’t include doctors’ charges, including radiologists, pathologists, surgeons, anesthesiologists.
In a Thursday telephone conference, CMS Administrator Seema Verma talked about her federal agency’s hospital price transparency efforts, with rules that went into effect this month requiring a public list of prices online.
“We believe patients are the most powerful force in our health care system for driving quality and value,” she said.
But with all the legislation and regulations over the past 10 years, the rate of increases in health care in America has not come down, she said.
Costs continue to skyrocket, she added, and millions of Americans are unable to get the care they need.
“The status quo is unacceptable,” Verma said. “Price transparency is critical.”
When patients are left in the dark, she said, there’s little opportunity to take cost into account. Sometimes, there are large price discrepancies for the same procedure in the same geographic location.
Verma said some degree of public pricing has been available for years, but most were available only in print form from an administrative office, or posted in a form that couldn’t be aggregated with other information. Online, basic information can now be compared between facilities.
Bryan has had its own price estimator online for a number of years, Collee said.
The CMS-required listing is an important first step, Verma said, and there’s no reason hospitals couldn’t do more, as Lincoln hospitals have.
“We are just getting started as we work to increase price and quality transparency throughout the entire health care system,” she said. “We have to do more.”
Greater transparency could increase competition in the health care market, she said, which could lead to quality going up and prices coming down.
“We understand that it’s more complex than just putting out the information,” she said.