Surgery pricing secrets: The challenges patients face

Patients are the losers in both the Democratic and Republican versions of the health care reform bills.  Proposed health care reform won't help patients find out how much health care costs before they get care and many hospitals aren't set up to help.

A new research paper from The Healthcare Blue Book (www.healthcarebluebook.com) entitled Surgery Pricing Secrets: The Challenges Patients Face, shows that it is almost impossible to get prices ahead of time if a patient plans to have surgery in a hospital.

Healthcare Blue Book researchers found that:

• It took three times as many phone calls and four times as long to get pricing information from a hospital.
• Hospitals would not provide guaranteed prices and price ranges often varied by more than 100%.
• ASCs were more likely to discount prices for cash customers; regardless of the patient's financial status.
• Facility fees are 3-4 times higher in a hospital than in an ASC.

Healthcare Blue Book researchers contacted hospitals and ambulatory care centers (ASCs) in three markets:  Raleigh-Durham, NC; Denver, CO; and Portland, OR.  Hospitals and ASCs were asked to provide the costs of an anterior cruciate ligament surgery of the knee for a patient without health insurance.

Queries were primarily about facility fees, but researchers also asked respondents about other fees associated with the surgery.

It's almost certain health care expenditures, which totaled about $2.5 trillion in 2009, will continue to climb by at least 6% a year.  Hospital costs are 31% of the total according to the Centers for Medicare and Medicaid Services. So what are health care consumers going to do?

The Healthcare Blue Book, an Internet content provider, offers a free consumer guide to fair pricing for healthcare treatments and services for local markets at www.healthcarebluebook.com.

"One of the main tenets of successful healthcare reform will be patients taking more responsibility for finding out what their care costs as they make treatment decisions," said Dr. Jeffrey Rice, Healthcare Blue Book CEO, and white paper author. "But until hospitals are able to provide exact pricing, managing out of pocket costs for both insured and self-pay patients is almost impossible."