Blog | Monday, October 14, 2013

More on prices


I have been thinking more about the price of health care services. I have already shared some thoughts about this, but this time I have a more personal story to tell.

I recently had an echocardiogram. I would score the indication as “uncertain” (not clearly appropriate or inappropriate) according to professional guidelines. As a cardiologist myself, however, I would have ordered one in similar circumstances without hesitation. So I did not think the test itself was a problem, until I got the bill.

The charges came to $925 for the echo and an additional $121 for pharmaceuticals (an injection of echo contrast material). There was an “adjustment” of $413 reflecting the discount previously negotiated by my insurance carrier, leaving me responsible for the balance of $633.

As I paid the bill, a number of questions came to mind, none of which I could answer, but all of which I ought to be able to answer if the pricing of health care services made any sense:
 Is $925 a reasonable amount to charge for an echocardiogram?
 How much of a mark-up, if any, was there on the contrast, and does that have an impact on contrast utilization?
 Was the “discount” negotiated by my insurer comparable to what other insurers had negotiated with the same provider?
 What do we charge for an echocardiogram in our practice?

I think you can see where I am going with this. There is an utter lack of price transparency in the current health care payment system. That, in turn, creates the common absurdity of patients being completely unaware of how much they may be expected to pay for recommended services until after the care is rendered.

This has got to change. We, as providers, need to understand the financial demands we are making on patients. Patients should, and will, demand to know more about the price of services before they are provided, especially as high deductible insurance plans become more prevalent. Price transparency and honest discussion of the charge for services needs to become standard practice.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Auscultation.