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Hospital price info alone won't help consumers make informed health care decisions

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Saturday, May 11, 2013, 12:01 a.m.
 

Various media made much to-do this week about the fact that hospitals charge different prices for the same procedures. Go to one hospital for a certain medical procedure and they'll charge Medicare thousands of dollars more — or less — than another hospital in the same town.

Breaking: The Tribune-Review told you that in September 2011. So please pardon my yawn.

As part of an award-winning, yearlong series called “Code Green: Bleeding Dollars,” colleague Andrew Conte and I reported how the cost for the same medical procedures can vary wildly not only by region and state, but within the same city and even in the same hospital. How much that procedure costs depends on who pays. Government and private insurers use complex reimbursement formulas that, in the simplest terms, make no sense to consumers.

“Code Green” (www.bleedingdollars.com) provided detailed examples, such as prices for an MRI scan that ranged from more than $1,300 at a hospital in Pittsburgh to $425 at a Monroeville clinic, that leave consumers scratching our heads.

So when the Centers for Medicare & Medicaid Services released “price information” Wednesday for 100 of the most frequently billed medical procedures for Medicare patients, I couldn't help but think we've been down this road. The issue now, it seems to me, is can we please do something about this?

As the federal Affordable Care Act, or “Obamacare,” phases in, the Obama administration is touting the pricing information as the next great thing since the iPhone. “Basic information about health premiums and hospital charges has long been hidden from consumers,” Health and Human Services Secretary Kathleen Sebelius told reporters. Reallllly?

When the almost impossible to navigate Excel spreadsheet was posted on the Medicare website, the Obama administration announced it was part of a plan to make health care more affordable and accessible. Though that's certainly a noble goal, the reality is the numbers are almost meaningless.

St. Clair Hospital might “charge” $22,785 to treat your pneumonia, but it doesn't mean that's the amount it will get paid by Medicare or private insurance payers. Medicare sets its own rates, and private insurers negotiate discounts. In other words, they don't pay the full $22,785.

The charge discrepancies are certainly fascinating. I looked through the spreadsheet and found that UPMC Presbyterian charges Medicare $26,226 to treat “chest pain.” The same treatment at Allegheny General Hospital is a $17,158 charge. Does a higher cost get you better care? It depends on who is doing the treatment. That's where the consumer is left hanging.

We need far more consistency from hospitals and doctors when it comes to pricing. And we need far more information about quality of care to make informed decisions. Here's a starting point: Can someone please make this new website more user-friendly for those curious enough to even look at this database?

Having price information for a medical procedure is not a bad idea, but it's only one piece of information needed to make an informed decision. Forgive me for pointing to “Code Green” again, but other issues that experts pointed out as crucial to containing costs include cutting down on hospital readmissions for preventable conditions and on aggressive, often unnecessary treatment hospitals give dying patients — sometimes when they don't even want it.

Instead of paying more money, let's pay more attention.

Luis Fábregas is a staff writer for Trib Total Media. He can be reached at 412-320-7998 or lfabregas@tribweb.com.

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