No one wants to waste money. We shop around for the best price for a car, a TV and other big-ticket items. Some of us even drive out of our way to save a few dollars on groceries or gas. However, most of us don’t think about medical expenses that way. We might not even think about healthcare costs until the bill arrives. But prices can vary significantly among your area’s doctors, hospitals, pharmacies, treatment and testing centers. Yet, research shows very few patients check out prices before a procedure or appointment. Finding a cheaper alternative with equivalent quality can save us hundreds, if not thousands, of dollars. But figuring out how much healthcare will cost you before you agree to a service is complicated. Yet, it can be worth your time and energy. Do you shop around for healthcare prices?
Are patients shopping around for price information?
The answer to that is a resounding NO. Recent research studied patients (with private insurance) who needed lower-limb MRI scans. Despite a significant difference in out-of-pocket expense, patients often went to high-priced locations for their MRIs, even when lower-priced options were available. (It’s worth noting that MRI pricing can vary by a factor of 5 or more across providers in the same geographical region.) In this study, all participants had access to a price transparency tool to compare MRI prices in their area.
Less than 1% of the patients chose to check out pricing before scheduling their MRI. And it’s not about finding a place that is conveniently located. On average, each patient bypassed 6 lower-priced options between his/her home and the location in which he/she received an MRI.
How much money could patients have saved?
If patients chose the lowest cost MRI provider, they could have reduced their out-of-pocket costs by about 30% and saved their insurance company about 40%. That translates to a savings of hundreds or thousands of dollars from shopping around.
Why did patients choose a higher-priced option?
Simply put, their doctors. Patients were heavily influenced by their referring doctor, an effect more powerful than their wallet. Not surprisingly, patients of doctors in hospital-owned practices were more likely to have MRIs in a hospital, a costlier option.
Are patients likely to make decisions based on money in the future?
The study’s authors don’t think the influence of doctors will lessen over time. They feel it is unlikely that a significant number of patients will use apps or websites to make decisions; instead patients will continue to follow their doctors’ recommendations about where to receive services.
What did other studies find?
Research published in 2016 evaluated the usage, and effectiveness, of an employer sponsored cost calculator. The website provided allowed users to learn the total price as well as their portion of the bill for over 300 healthcare services. The tool was used by only 10% it in the first year of availability and by 20% after two years. Results from this research found that offering a price transparency tool did not lower health care spending. However, one study found that a price transparency platform was associated with lower payments for lab tests, advanced imaging and office visits. Interestingly, some patients who use price comparison tools select more expensive providers because they think higher prices means higher quality, but that is often not the case.
Other studies have also found low rates of usage. Health insurers report limited use of their price transparency tools, with many members not even knowing about the tools. Most plans provide pricing information to members, but only 2% to 3.5% take advantage of the tools and information.
Why is this so important now?
Healthcare expenses are climbing. Having a good insurance plan through your job may not be enough to protect you from large medical bills. It is expected that in 2019 employees will pay more for healthcare for premiums and out-of-pocket expenses (e.g. copayments). A recent report showed that more than half of workers pay a percentage of the price of outpatient surgery and hospital admissions, instead of flat copayments, leading to higher out-of-pocket spending.
Are people at risk?
Unfortunately, both the health and finances of patients can be at risk due to rising copayments, high deductibles and high premiums for insurance coverage. Health can suffer when patients cannot afford appointments, tests, treatments and medications. Not surprisingly, research shows that people cut back on care when they have to spend more for it, even when the care is “necessary”. In a recent survey by Bankrate, 25% of women and 18% of men stated they, or a family member living with them, avoided going to the doctor in the past year because of money concerns, even though they needed medical attention.
Learn more about the impact of high medical bills in my blog post: The High Cost of Healthcare is Keeping Patients from Seeking Care.
What makes figuring out your expected costs even trickier?
Hospital bills are complicated and are therefore difficult to predict. There are charges for everything from the room itself, doctor charges, equipment charges, medications, procedures and more. That being said, one might feel confident that your insurance company will pay for a hospital stay under the terms of your health plan if you use an in-network facility. But, you’d be wrong.
An analysis of hospital bills of patients who had insurance through large employer health plans found concerning results. Researchers found that even when patients choose an in-network facility, 15% of their hospital stays included a bill from an out-of-network provider. How does this happen? Even in a hospital in your network, you can receive care from a medical professional who is out-of-network because he/she doesn’t have a contract with your insurer. The analysis found that this issue is more common with anesthesia and pathology claims. And it goes without saying, this poses a big issue for patients. You generally don’t know, and cannot choose or control, who gives your anesthesia or which pathologist is analyzing your tissue. Unfortunately, this puts you up a creek without a paddle, and there is little you can do about it.
Where else might you run into a problem? Emergency departments. The analysis found that bills which included an emergency room claim, for both inpatient and outpatient patients, were more likely to include an out-of-network bill, even when patients used in-network facilities.
What pricing information is available?
You’ll have to read next week’s blog post to find out!