Everyone is clamoring for price transparency in healthcare. Rightfully so. The amount of obscurity in finding prices is obscene. Then patients are stuck with insane bills, having had no clear idea what an MRI or a knee replacement would cost.
Legislators and regulators are trying to regulate price transparency into existence. It’s a noble effort, and I support it, but it’s not the ultimate answer. Federal hospital price-transparency rules already require hospitals to publish pricing information. The next step is making that information useful when a patient is choosing care.
Price transparency should not depend solely on legislation if consumers demand it. We expect auto dealerships to tell us what a car costs before we buy it. No sane person would buy a car without finding out the price.
Healthcare should be the same when patients have time and a realistic choice of providers. Consumers should demand prices and stay away from institutions that do not provide them.
A JAMA Network Open study put that expectation to the test. Researchers called 1,150 urology clinics, posing as relatives of uninsured patients seeking a kidney-stone consultation. 401 of 464 private practices supplied a cash price: 86.4%. Hospital-based clinics did so 69.7% of the time (354/508); academic clinics, 61.8% (110/178)
They adjusted for a number of factors: metro versus rural location, state Medicaid expansion status, whether the clinic accepted Medicaid, and median household income in its ZIP code. Some seem a bit arbitrary. However, even with adjustment, private-practice clinics were much more likely to offer a cash price than academic centers or hospital-based practices.
Yet another win for independent physician practices trying to cater to patients’ needs.
Consider what that does for patient care. It’s not just about treating the disease. By offering a cash price, doctors are protecting a patient’s autonomy and financial well-being. Patients can use that price to shop, budget, and compare. They can inquire about non-price benefits, such as shorter wait times. It also gives practices a reason to keep prices lower: if the quoted price is outrageous and patients have alternatives, they can take their business elsewhere.
To their credit, hospital-based and academic clinics more often reported financial-assistance options. A meaningful discount can help patients. But lets not forget: tax-exempt hospitals are required to maintain a financial-assistance policy.
Ideally, a patient would get a consultation price; find out what falls outside it; get information on the assistance available. “We have a program” leaves several of the patient’s original questions unanswered unless the next steps are usable.
For independent physicians, this is a concrete opportunity to compete on service. Make the cash price easy to find. Precedent is out there, such as the famous Surgery Center of Oklahoma. It lists procedure prices on its website and identifies exclusions. Put that information where a patient can find it, and make sure the person answering the phone can explain it. This is a way forward to a more affordable healthcare system.
A price-transparency mandate can have legal teeth—CMS can impose financial penalties—but it needs consumer pressure too. Patients need prices they can act on, and practices should compete for their business.
Trilliant Health did some math and the Plan reported prices don't tie out to the Hospital reported process. https://www.trillianthealth.com/market-research/studies/the-majority-of-hospital-and-health-plan-reported-rates-diverge-by-more-than-10 No Surprise Act had no teeth! 100% CMS, or congress (as No Surprise did not apply to MA plans)