Ever wonder why your medical procedure cost more or less than someone else’s?
To demystify the answer, you now can look up different inpatient medical procedures to see the range of pricing available in Washington state, based on 2016 amounts.
The new analysis from the nonprofit Washington Health Alliance found that even though price disparities are nothing new, seeing how much the amount varies for treatments within and among facilities is still an eye opener.
According to the alliance’s summary: “We expected to find a great deal of variation in prices between admitting hospitals, and we did. For example, the median price for a dorsal and lumbar fusion in Washington state is $60,620. The highest price is $118,375 and the lowest is $30,897.”
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The report offers some reasons behind the different costs.
“Hospitals may have different contracts with different insurers, each with a different negotiated fee. Or the number of medical groups with admitting privileges may vary, and these medical groups, in turn, may have different insurer contracts. Insurers, hospitals and medical groups can all vary in the strength of their relative contracting advantages and that all results in different prices.”
The analysis joins a nationwide push in medical price transparency, led by a requirement that took effect Jan. 1 for hospitals to publicly list standard costs for their procedures.
That effort has been problematic.
A January report in The New York Times noted that some facilities were using indecipherable coding to list the procedures or were listing inflated prices.
The Wall Street Journal reported March 7 that the Trump administration is considering a further requirement for health care providers to publicly disclose the negotiated prices they charge insurance companies for services to ultimately reveal the true cost of procedures.
According to the alliance’s report, its analysis “illuminates not only the great deal of variation between providers but, for the first time, within facilities themselves,” showing low, median and high amounts at each facility for different procedures.
For example, case prices for an appendectomy at Providence St. Peter Hospital in Olympia ranged from $14,613 to $29,683, with a median cost of $18,569, according to the online data. Case prices include both hospital and professional fees.
The report’s authors hope consumers can either use the information to compare facilities or use it to help budget their expense.
It also could prove revelatory for hospitals and doctors in seeing how competitive their facility is compared with other medical centers, information that also could be of interest to insurers, the report noted.
The alliance’s analysis is strictly cost-based and does not look at the quality of care or a comparison of outcomes. It also does not include Medicaid and Medicare patients.
A separate report also by the alliance looks at inpatient spending trends in the state to see which treatments in 2015 and 2016 had the greatest effect on health care costs in the state.
That report found that while spending was down, prices were not.
Of the 287 inpatient treatments reviewed, 21 added up to half the inpatient costs in the state, and five were responsible for 24 percent of inpatient costs: vaginal and cesarean delivery, knee and hip joint replacements, and dorsal/lumbar fusion (spinal surgeries).
Last year, the alliance released two reports on medical testing in Washington state, one that analyzed the cost of medical tests that held little to no value and another that estimated $341 million spent on unnecessary care in the state.
The alliance hopes putting the inpatient treatment cost comparison information online will serve both those involved in setting up insurance plans and insured consumers facing these costs.
Describing the analysis as “monumental,” Alliance Executive Director Nancy Giunto said in the group’s news release: “We hope this will motivate people to do their homework and help avoid unexpected medical expenses.”
To see the data:
▪ Inpatient price variations for specific procedures by hospital: https://bit.ly/2XRE7pO
▪ Inpatient price variations for specific treatment specialties and their subcategories: https://bit.ly/2NWZKQP
▪ Read/download the full reports: https://www.wacommunitycheckup.org