You know how you cross the border into Maine and suddenly the air feels cleaner and the pine trees tower higher? And the big blue sign welcomes you to “The way life should be”?
Turns out the sign applies to hospital price information, too — at least, more than it does in Massachusetts. I happened to be in a York Hospital lobby in southern Maine yesterday, and came upon a notice informing me that under state law, I had the right to ask for a list of the average price tags on all the most common procedures. Very transparent, I thought, impressed. It sure would be great to post that list on WBUR’s Healthcare Savvy social network.
Turns out it’s not so simple, though. I called York Hospital this morning and they haven’t gotten back to me yet, so I tried the Maine Hospital Association. Jeffrey Austin, the group’s vice president and lobbyist, gave me a very helpful rundown of the background on Maine’s price list. Our conversation, lightly distilled:
What’s the story of this price list?
Around ten years ago or so, Maine law was amended to require hospitals to provide the prices of common procedures. But paper lists are something of a “horse and buggy” version of price transparency, and about four years ago, Maine established an online database — run by the Maine Health Data Organization and funded by the hospitals and the health insurers. It’s publicly accessible and interactive, so you can “one-stop-shop” for common procedures. (The “HealthCost” section is here.)
The limits of the transparency: We can tell you what, say, knee surgery costs but there are all kinds of associated costs that we may or may not be able to tell you. For example, if you’re using a radiologist who happens to be a private doctor, we can tell you the hospital facility fee but perhaps not the radiologist’s fee. Also, we can tell you the cost for a routine surgery but yours might not be routine. Still, the price lists do give you the ability to get a general sense of the cost differences between facilities.
Do people use it?
I don’t have a sense that individuals are using it. But big payors are starting to use it — the people paying the bills at the end of the day are starting to use it. There are limits to it and frustrations to it, but it’s a first step. The biggest frustration people have had with our database is the timeliness of it — it doesn’t change quickly.
What are the payors doing with it?
The biggest example is the state health plan, which covers state workers. And they haven’t done this yet but they’re about to: They’ve come up with a tiering system to rate hospitals based on quality, and they’re going to start incorporating relative cost as well in their tiering system.
What do you hear from the public?
I think sometimes you’ve got to lead with the data to get people to start using it. I don’t know how much people are using it. As long as we have the insurance system, what people are exposed to are their monthly premiums and their co-pays and deductible. We have a lot of self-insured entities in Maine and so those companies and payors are the ones that are a little bit more familiar with the data.
A couple of things are at work here: Maine is very rural and it’s hard to shop around. And obviously it’s impossible to shop for emergency services.
And people just don’t tend to act as consumers with health care…
No, but in my limited anecdotal experience, I went from my old job, where I had a classic Cadillac insurance plan, to a new job where we have a high deductible, and that makes you a consumer.
I have yet to hear back from the hospital about the price list, but for now, it just so happens that the creative folks at medicalbillingandocding.org had just sent over this colorful infographic on ballpark surgery costs: