For years we have been told that the way to put the brakes to sky rocketing health insurance premiums was to let consumers shop and compare costs. While this pricing mechanism certainly works in markets where consumers have access to good comparative information, when it comes to shopping for health care services based on priced, your local psychic may have better information than is available from an Internet search. One doctor frustrated at the lack of medical cost transparency has started a website to help reveal the hospital costs for many health care services.
Medical price matters
Dr. Bill Hennessey, M.D., is the CEO and founder of Pratter.us, where their tagline is “medical price matters”. One of the big goals of Pratter is to have the prices for the most common health care services offered at all of the hospitals in the United States available to be searched through a comparative data base. Currently, Pratter only has hospital costs for the states of California, Maryland, Ohio, Wisconsin and West Virginia. Since I am California, I thought I’d try out the website to see how it worked.
Comparing hospital outpatient, labs, and imaging costs
I searched for some of more common health care services offered by hospitals in a fifty mile radius of Sacramento County zip code 95608. While there are numerous procedures and tests to select from, some of my searches such as turbinate reduction (nasal surgery associated with sleep apnea) and breast biopsy yielded no results. But that isn’t to say that those operations aren’t listed under another title. There were other operations like appendectomy, cataract surgery and cesarean section that weren’t listed. These too may also be under a different title or more medically specific and technical name that I, as a layperson, are unfamiliar with.
Local hospital prices
| Emergency Room visit, Level 2 low severity | $550 Kaiser | $676 Sierra Nevada | $685 Sutter, Davis |
| Imaging procedure | |||
| Computed Tomography (CT Scan) | |||
| Chest, with and without contrast | $6,637 Sutter, Davis | $6, 930 UC Davis | $8,062 Dignity/Mercy |
| Pelvic with and without contrast | $2,013 Sierra Nevada | $2,728 Kaiser | $5,281 Sutter General |
| Mammogram, screening | $153 Sutter Roseville | $195 Kaiser | $221 UC Davis |
| Magnetic Resonance Imaging (MRI) | |||
| Abdominal | $2,123 Sierra Nevada | $2,785 Kaiser | $3,417 Sutter, Roseville |
| Radiography (x-ray) | |||
| Wrist, 3 or more view | $348 Sutter General | $358 Kaiser | $558 Sierra Nevada |
| Abdominal, complete | $181 Sutter, Davis | $320 Sutter, Roseville | $770 Dignity/Mercy |
| Skull, complete | $225 Sutter, Davis | $384 Sutter General | $596 Kaiser |
| Sonography (ultrasound imaging) | |||
| Fetal, 1st trimester | $726 UC Davis | $776 Kaiser | $887 Sutter, Roseville |
| Lab test | |||
| Complete Metabolic Panel | $263 Sutter General | $357 UC Davis | $616 Dameron |
| Complete Blood Cell Count | $157 Dignity/Mercy | $161 Sutter General | $239 Dameron |
| C-Reactive Protein | $11 Sutter Amador | $20 Sutter Center Psychiatry | $53 UC Davis |
| Hemoglobin A1C | $114 Kaiser So. Sac. | $217 Dignity/Mercy | $220 Sutter Roseville |
| Lipid Panel | $560 Dameron | $566 St. Joseph’s, Stockton | $377 Sutter Roseville |
| Prostate-Specific Antigen (PSA) | $4 Sutter General | $29 North Bay Medical | $40 Sutter Amador |
| $198 UC Davis | $215 Kaiser | $367 Dignity/Mercy | |
| Testosterone, total | $299 Dignity/Mercy | $302 Kaiser | $376 UC Davis |
| Thyroid Stimulating Hormone (TSH) | $76 Lodi Memorial | $99 Sierra Nevada Memorial | $136 Marshal Medical |
| $197 Kaiser | $346 Dignity/Mercy | $358 North Bay Center |
Big price spread
The first thing you notice is pricing can vary greatly and even between hospitals within the same parent corporation. Sutter hospital has its own price for each image or lab while Dignity/Mercy hospital and Kaiser have consistent prices regardless of which campus you visit. Some of the lowest prices were at the smaller community hospitals such as Lodi Memorial, Sierra Nevada and Marshal Medical.
Non-hospital lab
As a comparison to the hospital lab test costs I searched the prices from Econlabs in the Sacramento area.
| C-Reactive Protein | $64 |
| Hemoglobin A1C | $43 |
| Lipid Panel with PSA | $135 |
| PSA | $43 |
| Testosterone, free and total | $99 |
| Thyroid Stimulating Hormone | $41 |
With the exceptions of the C – reactive protein and PSA test, the prices at the non-hospital lab were less expensive.
What about health insurance?
The missing part of the puzzle for Pratter and other medical pricing websites is the health insurance component. First, health plans have their own network providers. A Kaiser member can’t go to Sutter or Dignity/Mercy hospital for treatment because the Kaiser HMO health insurance will not cover those out-of-network providers. Exclusive Provider Organizations (EPO) like the HMO model has no out-of-network coverage. Even a Preferred Provider Organization (PPO) with out-of-network coverage may offer little assistance in covering a lower cost hospital’s service if you haven’t met the out-of-network deductible.
Forecasting medical prices
For estimating potential hospital expenses for a specific procedure, Pratter offers a little view into anticipated pricing. Pratter can certainly help individuals and families research future health care expenses in coordination with selecting a new health plan. If a household expects to have certain tests and procedures done on a regular basis throughout the year, consulting Pratter for hospital pricing and then finding a health plan that supports that facility can be of tremendous value.
Who helps a patient compare prices?
The overall health care delivery system fails the consumer on multiple levels. One glaring failure is the disconnection between when a physician orders a lab, image or procedure and any assistance for the patient to understand what the costs are and if they have options for lowering those expenses. I’m reminded of Aiden Hill’s odyssey to get therapy for his sleep apnea that he chronicles in his book The Midnight Stranglers.
What doctors and hospitals don’t tell you
Mr. Hill dutifully follows his doctor’s advice and referral for sleep studies, oral appliance and various surgeries only to find hidden costs associated with out-of-network providers and procedures denied by his health insurance. Not only could the hospitals not give him an accurate cost estimate for the surgeries and recovery, there was no assistance in comparing the very expensive Continuous positive airway pressure (CPAP) therapy machines. (In California hospitals are prohibited from hiring doctors so there is always the hospital invoice and then the attending physician and anesthesiologist bills.) Through Hill’s research we find that the system is rigged on many different levels to hide costs, deny claims, and gently direct outpatient procedures to a doctor’s “favorite” clinic.
One doc swimming upstream
Dr. Hennessey’s medical cost pricing website is a noble attempt to pull back the iron curtain of secrecy surrounding hospital charges. He needs the participation of more hospitals to at least nominally upload their prices into the Pratter.us database. But we also need the costs for all those outpatient labs, imaging, and surgery centers as well because many of them can be in-network for different health insurance plans.
Health insurance should support Pratter
When it comes down to it, the health insurance companies should be telling all their providers to submit their data to Pratter.us. It’s no secret that routine outpatient orthopedic surgeries, tests and imaging is less expensive outside of a formal hospital. Health insurance companies want their members to select the least cost health care service. Health insurance companies tell us that the top drivers for escalating health insurance premiums are prescription medications and expensive imaging such as CT scans, MRIs and PET scans.
Price transparency will help the whole system
Websites such as Pratter can help drive down the costs of health care and reduce the double digit increases to some health insurance plans. But we need everyone to get into the game: doctors, hospitals, and insurance companies. When we all get serious about tackling the lack of pricing information that has individuals walking blindly through the mine field of health care, we’ll see meaningful reductions in the cost of services and health insurance.