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Patients Can Compare Surgery, Hospital Costs

State Of Texas Does Not Provide Hospital Comparison Costs

POSTED: Friday, May 13, 2005
UPDATED: 5:54 pm CDT May 16, 2005

Whether it's planned or an emergency, hospital stays can cost a small fortune. So, can patients shop around for the best deal? The Local 2 Troubleshooters searched for answers.

Video

Houstonian Jonah Clute has had two hospital stays in the past year, including quintuple heart bypass surgery a few months ago. But she jokes that it wasn't the illnesses that almost killed her -- it was the hospital bill.

"It was $64,500. I said, 'I need another hospital stay right now,'" Clute said.

She's not alone. Local 2 asked her friends at a southwest Houston AARP meeting if they have seen high hospital bills and their hands go up.

But when the station asked them if they were able to compare prices between different hospitals before a surgery or procedure, no one raised a hand. Some even gave some pretty weird looks.

But there is a way to compare prices for medical treatments and stays.

Go online and other states run their own Web sites listing average surgery and procedure charges hospital by hospital. Texas is not one of those states, but Local 2 found a Web site by a nonprofit group listing prices at hospitals in Texas and in the Houston area for several common surgeries and procedures.

Looking at a comparison of "billed charges" for heart bypass surgery in Houston, the average charges range from $44,360 at one hospital to $131,410 at another for the same surgery.

The prices for a heart angioplasty range from $18,733 to $60,275.

For childbirth, charges ranged from $2,739 to $9,967.

Why the discrepancy?

"If you're a patient, you're not going to pay $100,000 more if you go to that hospital," said Dr. Vivian Ho, the health economics chair at the James A. Baker III Institute, Rice University.

Ho said those prices are not necessarily accurate and almost no patient pays the full rate. Instead, it depends on a patient's insurance.

"It's hard, in these situations, for me as a researcher even to give my father advice if he has an elected procedure of which hospital to go to," Ho said.

She said the real price a patient pays for a hospital stay is determined by the negotiated rate the insurer has with a hospital.

The more patients an insurance company sends to a certain hospital, the lower the price.

So, the one thing a patient can do to compare prices before going in for surgery or a planned hospital stay is to call the insurance company and ask about prices, hospital by hospital.

"The insurer will be able to know the price they negotiated with each hospital and will be able to give the patient some idea of the price of that procedure," Ho said.

But researchers agree that shopping for quality health care should not be this complicated.

Those who have had frequent hospital stays agreed.

"If you go the grocery store and there's 10 items on sale, you go to that grocery store. And so, I would see that and I could go to the most convenient hospital that was the best price," Clute said.

Cost Comparisons:

Response From Texas Hospital Association:

  • Why can't consumers compare prices for hospital procedures? Why is it so complicated?

    Answer: Consumers can compare prices, but be aware that the average "charge" or the "range" of charges may not help much. In reality, what the patient needs to know is what coverage is provided by his insurance plan, if the provider is part of the health plan's "network" and what his co-pay or deductible amounts are.

    Hospitals can and do provide estimates for elective procedures. One of the problems in providing an "estimate" is the uncertainty of exactly what the doctor will prescribe and how the patient will respond to the ordered treatment/medication.

    It's easy for consumers to know how much it costs to buy clothing, food and most other products and services. Unfortunately, purchasing health care is not like buying a car. When you buy a car, you choose exactly what options come with the car. You don't choose when to get sick or injured, and you may or may not choose where to go for health care services and which doctor cares for you.

    A doctor, not the consumer, orders the "service options" you receive. If you are insured, your health insurance company decides how much you have to pay, and how much providers are reimbursed for services. And, if you do not have insurance and do not qualify for financial assistance programs, the hospital cannot give you a discount because of current state law.

    Health care is different, and is a lot more complicated than buying a car or something at Wal-Mart.

  • Are there plans to make billing more transparent in the near future? What are some of the steps hospitals are taking now?

    Answer: Legislation is moving that would require hospitals and the Texas Health Care Information Collection to post the average charge for the 50 most common procedures. It also would require hospitals to provide cost estimates upon request prior to non-emergent hospital admissions or prior to scheduled outpatient procedures. In addition, hospitals, health plans and some hospital-based providers (such as anesthesiologists, pathologists and radiologists) will be required to notify patients that some of these physicians are not included in the health plan's network and may bill for the balance not paid by the insurer.

    Hospitals now provide cost estimates for elective procedures upon request, as well as work with low-income, uninsured patients to qualify them for Medicaid or charity care. Hospitals also will work with patients to establish time-payment plans. Hospitals continue to try to make their statements and the bill process more patient-friendly.

    In addition, THA requested legislation to remove the prohibition on hospitals' offering discounts to uninsured patients. The Legislature is poised to approve this legislation and give hospitals flexibility to work with uninsured patients.

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