Health Column: Transparency is coming to medicine
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
HERE’S THE DATA
CBC — $33
Chest X-ray — $296
CT scan of belly — $1,286
Screening mammogram — $229
Family Health West
CBC — $47
Chest X-ray — $229
CT scan of belly — $1,375
Screening mammogram — $244
St. Mary’s Hospital
CBC — $30
Chest X-ray — $200
CT scan of belly — $1,276
Screening mammogram — $199
It’s your wedding anniversary and you are celebrating at a really nice restaurant. You and your spouse have just sat down and opened your menus. Lobster, steak, scrumptious desserts… your mouth waters. Something is missing! There are no prices on the menu.
This is the dilemma that American consumers of health care face every day. What will my prescription cost — $5? $50? $500? How about the MRI of my knee? My insurance is not so hot. Will I have a co-pay or have to pay for the whole procedure to meet my $6,500 annual deductible? Will I get a better deal on the MRI at hospital C, hospital F, hospital S or at the orthopedic doctor’s office?
Last month, the Center for Medicare Services (CMS) began releasing data that detail Medicare payments to individual physicians, including billing rates and number of services performed. Immediately came an outcry from several organizations that people may not understand how to use the data. In my opinion, being transparent (Webster says, “to show oneself” and “being free from pretense or deceit”) far outweighs the early potential confusion. Misunderstandings and errors can and will be remedied. There are huge potentials to empower medical consumers and attack fraud.
How transparent are our local hospitals with respect to costs? In the last two weeks I called the CEOs of Community Hospital, Family Health West and St. Mary’s Hospital. All three of these men responded promptly and engaged me in thoughtful conversations about transparency of medical costs. They are tuned in and knowledgeable about the topic!
I asked for and received what each facility would charge a cash-paying patient (uninsured or underinsured) for three common out-patient radiologic procedures and a complete blood count (CBC). In addition, all three facilities provided me with information about the discounts they provide to uninsured patients who pay promptly.
Keep in mind, that these are charges for patients without health insurance. Trying to sort out the contracts that each of these hospitals have with different insurance companies is much more difficult. Secondly, the discounts that each of these hospitals offer may make them less expensive than their competitors. For the three X-ray procedures, you will receive a separate bill from the radiologist who reads your films. Finally, these comparisons do not address the issue of quality which is even murkier to sort out. Remember, Value = Quality/ Cost.
My Take: All three of our hospital leaders appear committed to making their charges to cash-paying patients available to all. Community Hospital has their charges online (except the chest X-ray) and Family Health West has plans to do so soon. These are significant steps forward. Finally, embarrassingly, I often write orders for tests or X-rays where I am clueless about what it will cost! When you incur charges for tests or hospitalizations, share your medical bills with your physician.
All menus need prices!
The opinions expressed are mine and may not reflect those of Rocky Mountain Health Plans or Primary Care Partners.
GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at email@example.com.
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The Valley Health Alliance invites small businesses and individuals who buy health insurance to Health Insurance 2022, a virtual panel and Q&A event set for 12-1 p.m. Wednesday.