New tools to make the infamous opaque medical prices more transparent show significant cost variability among state medical organizations.
Thanks to the Federal Hospital Price Transparency Act of 2021, Granite Staters is now able to compare prices for common procedures based on insurance plans. Above all, the intention was to help patients save money.
Most New Hampshire hospitals have a public list of common medical procedures and corresponding costs negotiated with insurance companies as required by the new law. Proponents want transparent prices to draw attention to areas where medical treatment prices are skyrocketing.
Prices for planned standard procedures can fluctuate significantly across states and even in similar geographic areas.
Still, there are limits to new commitments to transparency. It can be difficult to compare the exact same procedure between different facilities.
For example, at Elliott Hospital, it costs $ 9,445 to insert a catheter into the heart “for recording, pacing, and attempts to induce arrhythmias.” However, Elliott does not take into account the differences in insurance plans. This can be very different. At Concord Hospital, it costs $ 15,041 for patients using BlueCross as insurance and $ 3,842 for patients using Ambetter to insert a catheter into the heart for diagnosis.
Healthcare pricing can vary even within the same healthcare system, according to pricing data reviewed by monitor..
Emergency room rates for conditions of moderate complexity, such as mild asthma and head injuries, vary by hundreds of dollars at various locations at Concord Hospitals in Concord, Laconia, and Franklin.
Fees for low-level emergency room visits at Concord are now on average higher than Franklin and Laconia. Similarly, when comparing the median negotiated prices, Concord’s brain MRI claims to insurance companies are about twice as much as Laconia and Franklin in the same procedure.
The cost of a vasectomy at Concord is almost double ($ 758) from the median ($ 392) at Laconia and Franklin.
Concord Hospital acquired LRG Heathcare from bankruptcy in 2021 and is working to make costs between facilities more consistent.
“Our goal is to ultimately provide a consistent total cost across all three hospitals if the costs are the same. The process has not yet been implemented,” said Concord Hospital’s integrity of revenue. Erin Cutter, who is responsible for sex, says. “That said, there are many scenarios where it is not appropriate to provide consistent pricing due to the large number of variables.”
Concord Hospital’s cost estimation tool allows patients to compare prices based on procedure codes and insurance plans.
Experts say there are many factors that go into setting commercial reimbursement rates, including the duration of the procedure, the cost of equipment, consumables and services, the agility and complexity of the patients receiving the service. In other words, the estimated cost and the actual cost can be very different.
Dr. Elliott Fisher, a researcher at Dartmouth College who studies medical costs, said that in most cases higher prices are passed on to patients.
“They have to pay the first probably $ 5,000 or $ 10,000, so all of that is passed in terms of the price they pay through their high-deduction health insurance,” he said. “Otherwise, it’s included in the premium.”
Patients insured through their employers often still suffer from rising health care costs, Fisher said. Some health economists have found that when health care costs rise, employers often pay more premiums from workers or reduce benefits.
Shopping at the best prices in routine procedures can save individuals and reduce prices, Fisher said. However, it is not always practical, especially in urgent or urgent situations.
Some researchers have found these transparency initiatives to be successful. According to one study, a New Hampshire-wide transparency database reduced the cost of medical imaging, such as patient MRI and X-rays, by 3% in five years.
Lucy Hodder, director of health law and policy at UNH Franklin Pierce Law School, said price transparency and price comparison tools help consumers find low-cost alternatives, but reduce costs and improve access. Said that much greater systematic pressure was needed.
“Over the system, there is no accountability to actually reward or drive value,” she said.
Rising healthcare prices are becoming an increasingly burdensome for Granite Staters.
According to a 2021 report from the New Hampshire Insurance Authority, Granite Staters consistently paid higher health insurance premiums than the national average and most New England averages.
The same report also found that the deductible average for Granite Province was significantly higher than the average for the United States.
These higher than average costs can be due to several factors. New Hampshire is a small state. This means that the large costs of the industry, such as new cancer centers and expensive new miracle medicines, are distributed to relatively small groups and are more expensive for each individual.
The state has also undergone several hospital consolidations in recent years, which has been shown to increase hospitals’ ability to negotiate with insurance companies, resulting in higher prices.
Unlike some other states that have offices that hold healthcare groups accountable for prices, New Hampshire has little monitoring or accountability for healthcare costs.
Hodder said high prices are affecting people’s ability to access healthcare.
According to a national survey, one-third of Americans skipped care in the months leading up to October 2021 due to costs.
“Rising medical costs in New Hampshire are having a dramatic impact on families and businesses,” Hodder said. “I think our providers are having a hard time figuring out how to manage it.”
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