Price List Could Be A Radical Medical Tool

BOSTON — A one-page list of 56 common medical tests and procedures could shake up the way doctors deliver care at Beth Israel Deaconess Medical Center. Why? Because there’s a price next to each item.

Such lists are very unusual. Most doctors have no idea what they are spending when they order care for patients — and finding out is an eye-opening experience.

“I didn’t realize that the prices were as high as they actually were, although I knew that there were some pretty extreme examples,” said David Ives, a primary care doctor and the medical director of Affiliated Physicians Group, the largest group of private doctors that admits patients to Beth Israel.

Dr. Richard Parker reviews a medical price list created for doctors at Beth Israel Deaconess Medical Center. (Martha Bebinger/WBUR)

Dr. Richard Parker reviews a medical price list created for doctors at Beth Israel Deaconess Medical Center. (Martha Bebinger/WBUR)

“One [price] that really pissed me off,” Ives said, “was that when you send someone to an ear, nose and throat [specialist], something like 80 to 90 percent of the time they get a flexible scope of their sinuses.”

Ives says using this flexible cord with chip camera is rarely better than having the doctor look up a patient’s nose or down their throat, but it costs 10 times more than the physical exam.

“It’s just done because the technology is there,” Ives continued, throwing up his hands. “Is there value added for that? And I thought, probably not. And that might someday dissuade me from referring to someone who does a lot of those.”

Ives acknowledges that some ear, nose and throat specialists would disagree and argue that the scope is a valuable test. But raising that disagreement is part of the point of the price list. Phil Triffletti, another primary care doctor at Beth Israel, says that as health care costs continue to rise, physicians need to talk to each other about which tests or procedures are worth the money.

“Really, the increases are unsustainable,” Triffletti said. “We have a responsibility as health care providers to make sure we get the best health care we can out of the money that’s available.”

But considering costs and deciding what’s worth the money is not part of most medical school programs, says Neel Shah, who directs a website, costsofcare.org, that tries to help doctors understand how their decisions affect what patients pay for care.

“In medical school, forever, you’re taught: do no harm,” Shah explained. “If it’s safe and it has a reasonable chance of working, you do it and that’s it.”

Some doctors say considering costs as they care for patients is unethical. Shah mentioned the slogan that guides physicians at the hospital where he practices.

“The slogan at Brigham and Women’s is: ‘everything possible,’” Shah said. “So the question is: how do you re-frame cost conversations within the doctor-patient relationship. That’s a challenge because traditionally, it’s considered to be taboo.”

“We have a responsibility as health care providers to make sure we get the best health care we can out of the money that’s available.”
– Dr. Phil Triffletti

The taboo is lifting, Shah says, as more doctors realize that medical bills are the leading cause of personal bankruptcy; so, ordering care that isn’t clearly necessary can cause harm. The taboo may be pulled away as more and more doctors are responsible for managing patient medical budgets.

“I want doctors to think about the costs of the things they are doing,” said Richard Parker, medical director for the Beth Israel Deaconess physicians group. “It’s important to think about what something costs to understand its value.”

The price list is Parker’s idea. He says he hopes that using the list will help doctors lower health care spending while making sure patients get everything they need.

“We’re not saying don’t give patients what they need,” Parker said, his voice rising. “We’ll fight hard to get them what they need, but please don’t give them what they don’t need — we just can’t afford that anymore.”

You might be wondering where you can see the price list doctors at Beth Israel are using. You can’t — unless a doctor there shows it to you. Physicians, hospitals and most insurance companies don’t make prices they agree to in a contract public.

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  • Dianne

    “Some doctors say considering costs as they care for patients is unethical.” What’s really unethical is assuming the tests, procedures, and drugs pushed by big pharma is always priceless to every patient, especially when simple skillful assessment and care is in order (not just that of our doctor’s but that of ourselves). I hope this increase in cost awareness curbs the senseless funneling of money from our hard earned paychecks and health insurance to pharmaceutical companies that have proven records of coercion and unethical practices. And though I personally hope this kind of information will be available to patients as well, it would undoubtedly have a profound impact for those who are between a rock and a hard place when it comes to money and maintaining their health. It will be interesting to see where small changes like this lead us in the whole scheme of health care reform, because somethings gotta change.

  • Barry

    I wonder which “price” they are using. Is it what Blue Cross pays? Harvard Pilgrim? 

    • Martha Bebinger

      Hi Barry – I believe that most of the prices on this list are based on the Blue Cross contract, but that they were reviewed and are in line with Harvard Pilgrim and Tufts prices.  I did not see the price list, so I can’t be sure.  Thanks for the question.

  • Sean Palfrey

    This type of effort is very important, but as noted below, “prices” vary greatly depending on contract, setting, even time of day, and “costs” are almost impossible to know. Still, having a ballpark of the expense (to someone) in front of you each time a visit, a test, or a treatment is considered should be thought-provoking to the clinician and the patient, especially if payers put appropriate incentives and disincentives into contracts with clinician groups and patients have to contribute to those fees generated whenever they are seen outside of their medical homes. If we want all people needing health care in this country to get care, doctors, patients, hospitals, insurers and even lawyers will have to take cost to the “system” into account at every patient encounter. Check out this Perspective:  http://healthpolicyandreform.nejm.org/?p=13874  

  • Anonymous

    When my husband and I planned for an early retirement we were both in our 50′s. Not only were we retiring, but we were moving to Nashville, TN. Since we resigned from our jobs, we knew we would have to buy health insurance and dental insurance in Tennessee.  We purchased a PPO family plan, for just my husband and me, through “Penny Health”  . We paid for the family plan ourselves, initially, the cost was a little less than $400 a month for both of us. Our co-pay was very reasonable at $25 each per office visit.

  • Jhaddox7983

    They do the tests because lawyers know the technology is there.  The technology may not be better than a good physical, but in hindsight, a lawyer will say that it was…and a jury will award millions.  The problem is not the doctors; the problem is that the doctors are being forced by lawyers and an unknowing public to practice defensive medicine.  If and only if we get tort reform; if we leave the decisions about “best practices” to doctors instead of lawyers, then and only then will health care costs come down.

    • Guest

      I could not agree more…

  • Steven Scott

    I would love to see the list, not to know the prices charged at Beth Israel, but to see how it was constructed (result and the process), in order to do the same at my institution.  I think the philosophy behind the list is correct. 

  • Pdheart

    I was hoping the article would be about a price list shown to patients, who then decide if they really need the test (or maybe get it cheaper from another provider). You know, letting the patient have some skin in the game. But even in this context such a price list is useful of course. 

  • Jszydlo

    I think doctors who DON’T consider costs as they care for their patients are unethical.  They create unwarranted financial hardship resulting in patients not being able to afford medicaions they need and actually increase the risk of their medical demise.  The stress of financial hardship is also a detriment to the patient’s mental health.  Think hard about this.

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