Health Care Pricing and Quality Transparency Resources


Consumerism in health care is a tricky game because pricing and quality transparency aren’t easy to come by. Consumerism teaches us that there should be a direct relation between price and quality.  The old adage “you get what you pay for” is a realistic saying when you’re talking about buying a new car or computer, but it is simply not the case when you’re paying for health care services and procedures.  Patients and payers argue that it is impossible to find pricing and quality information on health care providers that is clear enough to influence purchasing decisions.

First, we must discuss the vast price variation in the healthcare system and why it exists.  Of course, certain patients prefer certain physicians for strictly personal reasons; perhaps they’ve always gone to see the same doctor and they trust them. However, a number of variables should be taken into consideration when measuring a practice’s level of quality.  In radiology, for instance, it is important to consider the following; accreditations and honors, the age of technology, the number of on-site radiologists, turn-around time of scans, years in practice, sub-specialties and the ability to conveniently perform needed additional scans.  Convenience and physician communication can also serve as quality factors for practices.

The issue is that patients often don’t know about these variables and are unaware of how to measure quality. Rather, they base their provider decisions on what other physicians tell them or what they have heard. They don’t know that they have options when their providers tell them to just go to Dr. Such-And-Such.

Often times, the most popular place to turn for care is a local hospital system, which in some cases could make be a delightful patient experience, but in most situations turns into an expensive and timely trip.  So why are hospitals so much more expensive if they aren’t better than independent practices?

There are a number of things that go into pricing for services and procedures, just think about all of the people that are involved in surgical procedures. Hospitals have to pay their staff, their physicians and all the fees associated with large hospital systems. In essence, you are paying for the bricks and mortar.  Additionally, many hospitals have higher costs in order to cover lost collections in other areas like emergency room bills and maternity bills.  When a patient needs an MRI for example, they might see hospital pricing as high as $1,300 while an independent imaging center only charges $325.  This has a lot to do with Medicare fee schedules but also resorts back to the fact that the independent practice probably has an onsite radiologist performing the scan who will be paid for his work directly, while the process is more expensive and not as seamless in a larger setting.

This is NOT to say that hospitals are not high-quality healthcare providers, in fact, the ways hospitals are reimbursed have been improved exponentially.  Rather than being paid for performing MORE procedures, they are being rewarded for quality based on patient satisfaction.  These satisfaction scores have whipped many systems into shape, forcing them into providing better care and working to lower health care costs.

So how are patients supposed to recognize quality health care in relation to the convoluted structure of healthcare pricing?  Many websites and resources have popped up with missions to create price transparency and methods of measuring quality in an easy and understandable way.  Here are some we support:

  • We created Save On Medical to allow patients better access to quality, affordable healthcare procedures.  Our Docometer Quality Scores and comparison tool, help patients look at cost and quality. Soon, our TruCost Calculator will also help patients see how much they would owe if they opted to pay for procedures with their insurance plan.
  • Parasail Health is a new company that offers patient financing and payment plans for patients who have racked up expensive medical bills and owe a lot of money to their doctor or hospital. They turn bills into simple monthly payments with low, fixed interest rates. A much safer bet than using CareCredit which can end up costing patients even more in ballooning interest rates.
  • If you need help negotiating medical bills, CoPatient is a great resource for patients. Their easy to use service helps patients ensure that the price they pay for their health care is fair and accurate.

Becoming an educated patient is key to “getting what you pay for.”  By researching, utilizing resources and learning more about the health care system; patients can feel confident that they are getting the best care possible at a fair price.