Massachusetts Launches Health Care Shopping Experiment : Shots - Health News How much is that colonoscopy? Finding out can range from hard to impossible. Massachusetts now requires that health care providers give patients prices within two days. But that doesn't always happen.
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Massachusetts Launches Health Care Shopping Experiment

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Massachusetts Launches Health Care Shopping Experiment

Massachusetts Launches Health Care Shopping Experiment

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Massachusetts is known as a testing ground when it comes to health care. And now the state has a new experiment underway. The idea is to find out whether health care providers can share the prices of procedures - for example, an MRI, stress test or the delivery of a baby - and whether patients armed with those prices change when and where they buy care. Since January 1st, hospitals and doctors in Massachusetts are required to tell patients who ask how much things cost.

WBUR's Martha Bebinger followed a patient who put it to the test.

MARTHA BEBINGER, BYLINE: Our sample shopper is a 32-year-old pregnant real estate agent from central Massachusetts. She sets out to get prices from three hospitals.

CAROLINE COLLINS: Hi, this is Caroline Collins. I'm just calling to find out about the price of a vaginal delivery in your OB department.

BEBINGER: The main switchboard at Health Alliance Hospital in Leominster...

COLLINS: Oh, thank you.

BEBINGER: ...transfers Collins to obstetrics, where a receptionist tells her to call the billing office at the parent hospital, UMass Memorial Medical Center in Worcester.

COLLINS: I'm due in June and my husband and I have pretty minimal coverage, just a really high deductible. So I just wanted to check and see what the cost would be.

BEBINGER: Collins' deductible is $3,000 a year. At UMass Memorial, Collins leaves a message for a woman who has a price list but will be out for two weeks.

COLLINS: And I hope you have a great time off and I'll see you when you get back. Thanks, bye.

BEBINGER: Collins tries another number at UMass Memorial and leaves another message. She moves on to Emerson Hospital, where she's transferred from the main switchboard four times before leaving a message for a woman who hasn't responded after two days. Into her third day of shopping, Collins finally hears back someone at the second hospital.

COLLINS: She said that the vaginal delivery would be between 10,000 and 16,000. And then if it turns into an emergency C-section it would be 20,000 to 30,000, depending on the operation and how it went. And she said that to give me a more exact number, she would need a CPT code, which comes from the doctor's office, I suppose.

BEBINGER: Your doctor's office has a code tied to the price of any test or treatment you need. And you need to know that code, a lesson Collins learned the hard way.

COLLINS: The experience was pretty frustrating from beginning to end. If was definitely surprising how many machines I spoke to within the last few days.

BEBINGER: All the hospitals Collins called say they are committed to complying with this new price requirement, which says they must quote patients a price within two working days but it's difficult. Each hospital negotiates prices separately with each insurer. Sometimes the hospital bundles all the costs into one bill, but sometimes the surgeon or anesthesiologist or lab sends their own bill. And then what you, the patient, actually pay on top of your premium varies if you have a deductible or co-insurance.

KAREN GRANOFF: It's very different from you go into Best Buy, you want to buy a refrigerator.

BEBINGER: Karen Granoff, with the Massachusetts Hospital Association, says her members are working with insurers to nail down prices.

GRANOFF: They know that they need to do this; they're not opposed to the transparency piece. I think they are worried about the challenge of getting the information to the patient.

BEBINGER: Doctors are also now required to quote prices for patients. Some large physician groups have purchased software that calculates a patient's exact expense. But many individual doctors say they haven't heard of this requirement. The state has no authority to make physicians or hospitals participate.

Dr. Ron Dunlap, president of the Massachusetts Medical Society, says giving patients prices is a good idea.

DR. RON DUNLAP: But I think this project is somewhat of an overshoot. It's just too broad. There are just too many different procedures. My thought is that we should focus on the most frequently used expensive procedures, and that's where most of the savings could be achieved.

BEBINGER: There are no plans to revise the pricing requirement. Barbara Anthony is Massachusetts Undersecretary for Consumer Affairs.

BARBARA ANTHONY: It's kind of - ridiculous, is the word that comes to mind - that we're actually talking about the pros and cons of whether consumers should know how much their health care costs. I mean, what other commodity or service do we ever debate whether or not a consumer should know the price of the item or the service before purchasing? You can't even name one.

BEBINGER: But you'll hear many doctors and hospitals say health care isn't like any other commodity. Collins is figuring that out. In the end, she only heard back from one hospital and didn't get anything close to an exact price for her delivery.

For NPR News, I'm Martha Bebinger in Boston.

BLOCK: This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

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