By Rachel Zimmerman
My doctor said I needed a pelvic ultrasound.
Fine, I said. Do you know how much it'll cost?
No idea, she said. But you can ask.
Great, I said. I love comparison shopping (especially when I don't have to pay).
To be honest, I never would have shopped around for an ultrasound if not for my colleague Martha Bebinger. She's just launched the cool, forward-thinking, social networking site, Health Care Savvy, which will serve as a forum for patients to compare prices, brainstorm on how to get costs under control and generally vent.
So, motivated to become a savvier health care consumer, I set out on my journey.
My family has Blue Cross Blue Shield of Massachusetts health insurance through MIT, where my husband works. So, the first thing I did was to call the referral office to find out what my options were for getting the ultrasound. (The details of why I needed the ultrasound aren't necessary here, believe me. Suffice to say there were some questions about minor bleeding. But don't worry, it turns out everything's OK.)
I had three choices: Massachusetts General Hospital in Boston; Mount Auburn Hospital in Cambridge; and Diagnostic Ultrasound Associates in the Longwood area. I asked the nice referral lady what the costs were at each. Call billing, she said. At referrals, no one has the prices for services.
All of Billing seemed to be on vacation. At least that's what I figured since I pressed all of the possible extensions available and got no human voice. So I went back to referrals and talked to someone else who told me, eagerly, my ultrasound wouldn't cost a thing, no co-pay, nothing. "I don't want to know what it costs me, I want to know what it costs," I explained. Silence. I was told to call each medical facility separately for that.
3. Three Prices
I called each facility, and here are the prices I was quoted for a pelvic ultrasound:
--Mass. General: $2847 or $2563 (more on this later)
--Mt. Auburn: $971.96
--Diagnostic Ultrasound Associates: $516
All three quotes were for the imaging only and did not include professional services or other additional costs, I was told.
So, is it just me, or is a five-fold difference in price for the same procedure at three greater Boston facilities kind of shocking?
I called MGH back to make sure I heard right. Weirdly, on Wednesday, the ultrasound price was $2,847, but on Thursday it was $2,563. (Do I hear $2,000?) I called the hospital's PR office for a comment on why it costs so much more. Here's the statement they sent me from Sally Mason Boemer, Senior Vice President of Finance: “MGH typically benchmarks our gross charges with like institutions and find our charge levels to be consistent with other urban medical centers that have a significant amount of complex care, teaching and research missions, and a high uncompensated care burden."
OK, I get that pricing isn't simply about pricing. Hospitals have higher overhead than stand alone imaging clinics, for instance. And I understand that Partners HealthCare, the parent of MGH and the Brigham, needs to subsidize the very important, but often money-losing parts of its business (like Paul Farmer and the Division of Global Health Equality at the Brigham and providing psychiatric care and a round-the-clock burn unit, to name a few).
But still, from a patient perspective, the choice seems more straightforward: it's the $2,500 ultrasound vs. the $500 one.
4. Not Like Buying A Car
The question I keep coming back to is this: Why is paying for health care so different than buying a car or paying for private school or getting a pedicure? Why is health care the only valuable item we purchase blindly, in effect, with absolutely no idea how much it costs?
Jeff Levin-Scherz, an assistant professor at Harvard Medical School and Harvard School of Public Health (and also a doctor, former health care executive and blogger) explains via email that "health care prices represent an intricate web of cross-subsidization and historical accident. Consumers rarely have access to prices – and even physicians often have little idea what patients will be billed. Consumers care more about prices now, as more have high deductible health plans. Many employers are also starting to consider reference pricing – where they will pay a set fee for a service, and patients will pay the difference if they go to a more expensive provider. "
Robert W. Seifert, Principal Associate at the Center for Health Law and Economics at University of Massachusetts Medical School said the different prices I was quoted for my ultrasounds were "certainly eye-opening."
But, he wrote, also by email, it will take more than just knowing what health care costs to change the system:
More transparency about what different facilities charge for the same service and more price-consciousness on the part of consumers (and their accountable care organizations, as we move away from fee-for-service and toward more global financing) will undoubtedly narrow this range. But it won’t do away with it completely, and not because the higher-priced facility necessarily delivers a higher quality service. It’s because a big hospital must build more costs into its ultrasound price – a piece of the costs of running the hospital, supporting its research mission and training new clinicians – than a business that does just ultrasounds.
The value of a provider’s brand and the provider’s market strength (and the market strength of the insurers with which it negotiates) also affect the price. So an easily accessible price list (a smart phone app?) gets us only so far. The rest is a community-wide discussion about what we should pay for, what is the most effective and efficient way to provide certain services, and how costs that ultimately benefit all of us (like research and medical education) should be covered.
5. Location, Location, Location
Clearly, all of this blithe ignorance (mine included) about pricing has huge implications. Pretty much everyone knows that Massachusetts is desperately trying to figure out how to control ever-rising health care costs. What we don't seem to get, however, is that until patients know the actual cost of their care, they will remain disengaged from the debate, and it will be left to the politicians, hospitals, insurers and other entrenched interests to figure out how things will look in the future. And that's why Martha's HealthCare Savvy site, with its focus on patients and honest discussion, is a great first step.
In the end, since my ultrasound was totally covered by insurance, I kind of ignored the prices and went to Mt. Auburn. Why? Well, I gave birth to both my children there, so I've got a bit of nostalgia for the place, but the honest to God reason for my choice was...parking. With my Cambridge neighborhood sticker, I got a free spot right down the street.
(A 2011 Favorite)
This program aired on August 17, 2011. The audio for this program is not available.