Devil’s Advocate: The Challenges in Price Transparency

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We’ve been yelling from the rooftops, promoting price transparency for the last three years. It has been assumed that showing patients how much their medical procedures cost will help drive down prices, improve patient consumerism and promote providers to offer affordable options. Providers across the country have jumped on board with the transparency plan, but there are a few roadblocks affecting the success of this bursting industry:

  1. Charges are not the same as prices

As consumers, we are trained to believe that when we see a price, that is all we will be charged for the product or service. In health care however, if you are able to find a price estimate for a procedure, that often does not take into account additional fees. Ex: Radiologist-reading fees at hospitals tacked on after the procedure

  1. Translating quality metrics into useful information can be subjective

Every patient is unique and rarely is one patient’s experience the same as another’s. Quality can be subjective when patients are judging a provider based on things like whether or not the nurse smiled or frowned and whether or not the patient was pleased with their diagnosis. To have true quality transparency, it needs to be clear that each provider is being compared apples to apples.

  1. Specialists and providers often bill patients separately for a procedure

Some providers are able to provide bundled payments, but when multiple specialists and providers are part of a patient’s experience they will often send multiple bills. For instance, if a patient is examining the cost of a surgical procedure they have to consider whether or not the anesthesiologist, the physician and their home health provider will charge them separately.

  1. Insurance payers have different pricing set for different care providers

Understanding what a patient in a high-deductible health plan is responsible for as far as charges versus an uninsured patient or someone electing to pay out-of-pocket really varies. On the same note, different insurance payers have varying contracted rates with care providers, so determining true costs across the bar gets confusing.

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