What Every Patient Should Know About Shopping For Health Care

Within a 7-mile radius in greater Boston, the pricetag for the very same diagnostic test varied widely, from $500 to $2,500. "Eye-opening," was the way Robert Seifert, a principal associate at the Center for Health Law and Economics at the University of Massachusetts Medical School, described it.

My family, like most in Massachusetts, has health insurance that covers this type of test, so normally I wouldn't have cared too much about the cost. But I was motivated to find out because a colleague, WBUR's Martha Bebinger just launched a new social networking site, Healthcare Savvy, that allows patients to compare prices, share ideas on bringing down the cost of health care and generally vent.

So, inspired by this new community, I set out to do something radical: comparison shop for health care. Here's what I learned:

At the prestigious downtown Boston teaching hospital, Massachusetts General, I was quoted a price of $2,563 for my ultrasound. At the well-respected community hospital, Mount Auburn in Cambridge (where both of my children were born), the price was $971.96. At Diagnostic Ultrasound Associates, the stand-alone imaging center in the Longwood section of town, I was told the price was $519. (After I posted my story on the Savvy site, I got a note from the interim CEO of another Harvard teaching hospital, Beth Isreal Deaconess Medical Center, who said at his hospital, the test would be $307. Sold.)

With national health reform unfolding, and pressure mounting for greater price transparency and lower costs, patients are being pushed, inexorably, to become smarter health-care shoppers. Right now, most of us still have "no skin in the game" as the policy types like to say, meaning, essentially, we don't feel the pain of paying for our health care. Sure, we cough up cash for co-pays and deductibles, but for the majority of families and individuals, insurance pretty much covers the bills and we remain blithely ignorant about what our health care actually costs.

[module align="right" width="half" type="pull-quote"]At Massachusetts General Hospital, I was quoted $2,563 for an ultrasound. At Diagnostic Ultrasound Associates, the price was $519.[/module]But that will soon change: high-deductible plans are on the rise, "tiered products" with their pay-more-to-get-more approach are looming, and costs are increasingly being passed along to consumers. Anticipating this inevitable shift, the Obama administration this week proposed the so-called "plain English" mandate — that is, new rules that would require health insurers and employers to provide consumers with information about health benefits, coverage and costs in language they can actually understand.

After writing about my own ultrasound pricing spree and reading the initial posts on Healthcare Savvy, I've come up with a short list of three key concepts that the modern health care shopper should know.

There's still a good deal of fear among patients about asking a doctor or any medical provider about cost. It feels somewhat shabby, a little unseemly. After all, the intimate relationship between physician and patient is all about healing and caring; it's not supposed to be tarnished by money or bargaining over price, right?

So, one of the most helpful tools on the Savvy site is "How To Ask...", a section that includes guidance and actual questions for doctors, nurses, billing clerks, insurers, etc., simply scripted for patients who may not know quite how to begin such discussions. Martha B. explains:

If your doctor doesn’t want to talk about it, we don’t suggest creating a confrontational situation. But we also do hear from a lot of doctors who are frustrated themselves, about the way pricing and payments and such in the health care system work, and they want the information about what they’re doing, as much as patients do.

Sometimes, simple solutions in health care can be the most effective and the cheapest. Amy Lischko, of Topsfield, Mass., posted an illuminating story about taking her 7-year-old son to a well-child visit at the pediatrician's office. During the visit, the doctor diagnosed a plantar's wart on the boy's foot. Lischko writes:

We were referred to a dermatologist who the doctor said would treat it by freezing it off — “cryotherapy” in several sessions. My son was not excited about this and I couldn’t blame him! While discussing it with another mother the next day she suggested an unusual solution…..duct tape! She said her daughter had the same problem a while back and her doctor said to put some duct tape on it, wait until it falls off, use an emory board to smooth it down and then put another piece of duct tape on it. Within 6 weeks it will be gone. Painless and almost free. I was skeptical upon hearing this so I called his pediatrician and the nurse said that it had been shown to be effective and that it would probably work. Why hadn’t I been told upfront about this effective, non-invasive treatment? Why was the more expensive, more invasive treatment the first course of action? This is an example of what is wrong with our medical system.

Lisa, who works at a global technology company based in Andover, Mass., learned about cost the hard way: with a $4,000 bill for the birth of her child that her insurer has so far refused to pay. It's a mess — she's covered by one health plan, her husband has another, and due to the complexities of bundled maternity care in the state, neither insurer wants to pay. After 20 to 30 calls and countless hours (on top of a full-time job and a new baby), Lisa says her husband's insurer has indicated that, with the right paperwork, the plan may reimburse some of the costs. But it's only through the couple's perseverance and patience that they may, ultimately, get the bill cut down.  Stay tuned.

At this point, we're still a long way from figuring out how to deal with the cost problem. But consumers are slowly becoming more conscious of the issue, and our growing sense of outrage when faced with irrational, seemingly arbitrary pricing is surely a motivating force to help fix things.

As for me and my ultrasound, in the end, since my insurance covered the entire cost, I chose the test site based on...parking. I found a free spot down the street from Mt. Auburn and was in and out of the hospital in less than half an hour, and on my way home. Oh, and the ultrasound was normal.