In the category of: Why wasn’t this already a thing? Massachusetts recently became the first state in the nation to require health care facilities and insurance providers make cost-of-service estimates available to patients in advance of undergoing medical procedures.
Having information about how much a procedure will cost ahead of time allows people to shop around for better deals. There is also hope that this level of transparency will lead to competition among hospitals and lower prices for patients.
But as with almost anything having to do with healthcare, getting a cost estimate isn’t as simple as you’d like it to be.
Procedure cost information is available — if you know where to look, who to talk to and can figure out complicated insurance terminology.
The new system has patient advocates and healthcare officials calling for improvements.
Passed in 2012, the state Law for Health Care Cost Reduction went into full effect on Oct. 1. The law requires insurance providers maintain websites where members can search and compare the cost of healthcare services with between in-state institutions. It also requires medical centers to respond to direct patient cost-of-care inquiries within 48 hours.
While insurers are providing this information on their websites, it’s not as simple as looking at a list of procedures and prices. Cost estimates for standard procedures such as CT scans and MRIs are mostly available for each area hospital, but for surgery estimates a patient may have to call each institution separately.
Health Care for All Research Director Brian Rosman said the prices provided online are “binding estimates,” meaning legally a patient can’t be charged for more than the estimate as long as the estimate corresponds exactly with the services rendered — that’s the tricky part. Insurance providers would be at risk of losing money if they gave — and then were held to — a surgery estimate that didn’t take into account a particular patient’s needs.
“Patients should be guided as to how to use these tools,” Rosman said.
The state Office of Consumer Affairs and Business Regulation, which oversees compliance with the new law, encourages patients to call their insurers for help using the tools.
We took a look at one of the online insurance tools, Tuft’s “EmpowerMe.” It has information about local medical centers, yet the quantity of information available varies from institution to institution, making it hard to compare prices. EmpowerMe has cost estimates for CT scans, MRIs, ultrasounds, and x-rays, but prices for most other procedures are either not available or difficult to dig up.
For example, a CT scan of the head and brain costs: $705 at Noble Hospital in Westfield, $583 at Franklin Medical Center in Greenfield, $456 at Baystate Medical Center, $451 at Cooley Dickinson Hospital in Northampton, $449 at Wing Memorial in Palmer, and $349 at Mercy Hospital in Springfield.
Benjamin Craft, a spokesperson for Baystate Health Systems, said patients don’t appear to be using the online resources yet — at least not locally.
“The tools available now have not quite reached the level of user friendliness to where a lot of patients are using them, and they’re really difficult to understand,” Craft said.
Even if more patients were able to figure out their insurer’s online system, Craft said the sites don’t tell the whole story about a hospital’s quality, just their prices. For example, he said, Baystate Medical Center in Springfield is a tertiary care facility, meaning they are required to have more round-the-clock coverage in case of trauma. This raises Baystate’s prices above what some smaller hospitals are charging.
“With higher quality outcomes you’re getting better value,” Craft said.
Tufts’ EmpowerMe does offer some quality rating information. When we checked it out on Nov. 28, there was data available for Baystate and Noble, but no such metrics were for Cooley Dickinson, Franklin, Mercy, or Wing Memorial.
To navigate the complexity, Rosman said he and the team at Health Care For All recommend insurers provide easy to find, simple instructions for their websites. Health Care For All also recommends that points of health care quality be fully integrated with pricing information within the Web tools.
“We think that’s something as important as knowing the costs,” Rosman said.
Barbara Anthony, undersecretary with the Office of Consumer Affairs and Business Regulation, says the new system is a work in progress with hospitals and insurance providers still adding data to the sites.
For help understanding medical pricing, Anthony suggests people visit the state-run website, getthedealoncare.org, for links to each insurer’s new online search tool.
Anthony said insurers are working to compile additional data and that more procedural prices will be added in coming months. She said that in looking through Boston-area providers, she found that they now all had searchable birthing prices, but western Massachusetts is a little behind. EmpowerMe, for example, did not show birthing prices under profiles for local institutions.
“You cannot have a competitive market unless providers are aware of one another’s prices,” she said.
Christina Trinchero, a spokesperson for Cooley Dickinson Hospital in Northampton, said the hospital was ahead of the curve on providing cost estimates.
“Even before the law went into effect, our goal was to respond to inquiries about prices within 24 hours, which is 24 hours sooner than what is mandated by the law,” Trinchero said.
Insurers have asked Health Care for All for feedback on the online tools and Rosman said the organization will soon issue report cards to insurers based on the quality of their Web tools.
“We want to empower people to really be in the center of their health care decision making,” said Anthony. “What we’re trying to do here is change the culture. This is a process that will grow as people become more educated about it.”•
