Consumers face many obstacles when it comes to finding out in advance what it will cost to see a doctor or have a procedure done, a panel told a state group assembled to look at pricing transparency in health care.
“What they’re really interested in knowing is how much this is going to cost me, and they want it in a very clear, easy-to-understand fashion,” Barbara Schneeman, vice president of communications and public affairs at RiverStone Health in Billings told a state panel Friday in Helena.
“They don’t want to be confused with different (codes). They just want to know if I come in today and see a provider how much this is going to cost me.”
The 2017 Legislature considered four bills that would have expanded a current law that requires health care providers to give certain cost information to consumers for treatments of more than $500, if the consumer asks. All of those bills failed, but lawmakers did pass a study resolution to examine transparency in health care pricing.
The group that is studying the issue met for the third time Friday; one more meeting is expected before the committee may develop any recommendations for the 2019 Legislature.
Ward VanWichen, chief executive officer of Phillips County Hospital in Malta, told the committee that people who come to his facility want to know the cost of things. But the difference between the price of a procedure is not the same as what a patient is charged because of variations like different health insurers, coverage levels, deductibles and other medical issues that may differ from person to person, he said.
That’s illustrated, said Stacey Anderson communications and public affairs manager for Montana Primary Care Association, by one mid-sized community health center she spoke with who works with 82 different insurance products.
“There’s a real concern at the provider level that we don’t want to give the wrong information to our patients,” Anderson said. “That’s what makes it such a complicated conversation.”
For the physical therapy patients Gary Lusin sees in his Bozeman practice, there’s a lack of faith in the medical system when it comes to pricing.
“Consumers want to trust what they hear,” Lusin said. “There is an element of distrust in the information they’re getting. They also don’t understand why it is so complicated to get a price on something. They should be able to get into a doctor’s office, a provider’s office, and be given a piece of paper with a price.”
Schneeman said that while all costs should be transparent, and she’d like a broad range of services included in a health care transparency tool, it’s more complicated than just giving patients a list of prices.
“The reality of that happening given the different expenses — I’m not sure it’s able to be done in a really efficient, easy way at this point.”
One example: A colonoscopy would cost less for a healthy person than someone with several other medical issues.
State Rep. Kathy Kelker, who chairs the subcommittee, said that while there are hurdles to getting better pricing information to consumers, it’s something that needs to happen.
“It is a complex topic, but folks are tackling it and we are as capable as anyone else,” said Kelker, D-Billings.
The are some statewide tools to get an idea of how much care might cost, such as one on the Montana Hospital Association. It operates a website called MHA PricePoint System that lists the average costs for inpatient or outpatient services, as well as other services such as diagnostic procedures at facilities around the state.
A person can use the site to search for the cost of care by county or city and then by facility. However it’s not a pricing quote, just an average cost of care.
The website shows how many patients received the type of care, the average length of stay for inpatient services, the average charge at the facility and similar ones around the state. People can also compare prices for services from hospital to hospital.
Roberta Yeager, information services director for the association, told the panel Friday that while the website is a good place for patients to start, people are always encouraged to call the facility for specifics because some hospitals may not include services such as anesthesiologists in the price of care.
Analytics provided by the association showed that in 2015, the site had 9,478 page views; 6,880 in 2016, and 3,500 in 2017.
Schneeman said that she wants to make sure that people understand the information they receive.
“We need to make sure we are creating and crafting those tools in a way that consumers can understand them and get the information they need so they can be good consumers of health care and make those decisions,” she said.
John Doran, divisional vice president of external affairs and chief of staff at Blue Cross and Blue Shield of Montana, said his company also has cost estimator tools that can help people insured with Blue Cross get an idea of what 1,500 elective services would cost.
One example he provided Friday showed an almost $30,000 difference in cost for a surgery procedure from one hospital to another. The rankings on the Blue Cross and Blue Shield site show both price and quality ratings of the hospital.
Doran, along with several others Friday, stressed that price is not always the deciding factor for people who may also make health care costs based on where family lives, where their doctors are or if it’s a good time of year to travel.