Want to know price of your surgery? Challenge for cost-conscious consumer

EDITOR’S NOTE: This is the second of a two-part series about new choices in health care. In the first part the Business Report looked at how consumers in the Boulder Valley can find the right insurance plan and lower their medical bills. For part two, Business Report reporters “shopped” for a number of health-care procedures at area hospitals to compare prices. While the numbers were fairly consistent between hospitals, getting the pricing information proved to be a challenge.

Consumers are paying more attention to the cost of doctor visits, medical procedures and hospital stays, especially as many increasingly take a personal role in controlling their health costs.

As both companies and individuals enroll in high-deductible health savings accounts, or HSAs, consumers are comparison shopping, and Web sites are popping up around the country with average pricing information for many procedures.

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The Boulder County Business Report found, however, that specific price information for surgeries in local hospitals is not accessible conveniently for consumers.

Their reluctance, hospital representatives say, is due to different costs negotiated with insurers, the difficulty of estimating how serious a surgery may be or if there could be complications as well as each patient’s health-care history.

With the range of prices the hospitals did provide for specific procedures, the Business Report found that base prices for procedures can vary by thousands of dollars between hospitals.

For example, an average total knee replacement at Longmont United Hospital is $16,000 less than the same procedure at Avista Adventist Hospital in Louisville. But hospital officials warn consumers shopping for health care that base prices aren’t the full story.
Many other discounts, deals and variables come into play, making consumer price shopping a difficult task.

Longmont’s knee surgery price may be less expensive. But Avista, for example, will negotiate a 40 percent discount for uninsured patients if they pay their bill on time. Longmont’s uninsured discount is only 20 percent.

That $16,000 savings at Longmont United now becomes just $1,000 in savings for the uninsured patient. Similar discounts are negotiated with the insurance companies. But the discounts vary by insurer and procedure. Insured patients need to consult closely with their insurer to find what is covered at what price.

Despite all these variables, the base price is still the starting point, and The Boulder County Business Report asked the four area hospitals – Boulder Community, Longmont United, Avista Adventist in Louisville and Exempla Good Samaritan in Lafayette – for their base prices of five common medical procedures: gall bladder removal, childbirth, cardiac catheterization, colonoscopy and total knee replacement. The base price includes all hospital charges, but does not include charges from the physicians.

In each case writers identified themselves upfront as Business Report reporters trying to get a consumer’s perspective. And in each case, hospital representatives were reluctant to provide pricing information, although all did eventually provide numbers, which are presented in the accompanying chart.

Hospital representatives emphasized that any consumer is welcome to visit their hospital prior to admittance and speak with a patient representative to get an idea of what the cost of their procedure might be.

Initially, each hospital representative referred reporters to the Colorado Hospital Association’s 2004 Hospital Charges and Length of Stay Report, www.chha.com/download/crpt04np.pdf. The report includes average charges and length of stay for the 35 most common inpatient medical conditions and procedures performed in Colorado hospitals.

The report is updated yearly; the new report with 2005 data should be released in August.
Avista Adventist is owned by Englewood-based Centura Health. Centura has a link to the report on the “Road to Transparency” section of its Web site, www.centura.org. Centura spokeswoman Dana Berry first directed reporters toward the site, but later provided specific, up-to-date numbers when writers said they wanted more current figures other than the 2004 report.

“The issue is comparing apples and apples,´ said Boulder Community Hospital’s Director of Public Relations Rich Sheehan. “We’ve had calls about these before. It becomes hard to make a true comparison. Some hospitals may include something in the fee that another would bill separately.”

Sheehan said he could only provide estimates. “Like a cardiac cath,” he said. “If they go in and do a cath and you need two stents, and the fellow after you needs four stents, the cost is going to be very different.”

While consumers continue to call for better upfront pricing, it isn’t an easy demand to fulfill, said Longmont United Hospital spokesman Matt Hartzler.

“Health care isn’t really a tangible product,” Hartzler said. “It’s not like shopping for a car, where you can go to several lots, test drive the vehicles, compare prices and make a decision.”

Even if hospitals began putting their prices online, it wouldn’t help consumers much, Hartzler said.

“You could go online, punch in the procedure and get a price, but it doesn’t consider the discounts with insurance, or the extra costs for any complications,” he said. “So the issue really isn’t the availability of the information, it’s the interpretation of the information.”

Hospitals worry that if they start posting prices online, consumers will cry foul if they don’t receive that price at the end of the day, Hartzler said.

Longmont United, for example, reported that its average price for a colonoscopy is $1,226. It is unlikely that any patient, however, will ever pay that price, Hartzler said.
Each insurance company negotiates a different discount on the procedure, resulting in different prices. Even for the uninsured, hospitals offer different discounts based on a patient’s ability to pay. Then there’s length of stay to consider; days spent at the hospital is another factor. Complications may lead to other procedures and charges.

Even with all those variables, hospitals should be more willing to open their pricing books to give consumers a ballpark figure in a timely manor, said Ben Davis, communications director at the Colorado Consumer Health Initiative in Denver.

“Right now the health-care industry is like eating at a restaurant without the prices on the menu,” Davis said. “The way the system works, there is no standard pricing in hospitals that’s accessible to consumers.”

While all four hospitals say they will sit down and discuss pricing with patients, Davis said the consumers he’s talked to, who try to comparison shop, come away empty-handed.

And while hospitals frequently blame the insurance companies as the biggest variable in pricing, Davis pointed out that nearly one in five Coloradans is uninsured. “That means that one in five Coloradans have to compare prices directly at the hospitals,” Davis said.
As reluctant as they may be at putting prices online, hospital officials say they are working to do just that.

“Consumerism in health care is growing,´ said Sharon Burnette, director of communications and marketing at Exempla Good Samaritan. “We have to be prepared for that.” Exempla is considering putting some of its prices online.