May 21, 2018
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Knowing health care prices is just the start. Now, act on them

Kristyna Wentz-Graff | MCT
Kristyna Wentz-Graff | MCT
Freedom Physical Therapy co-owners Peter Stathas, left, and Mike Karegeannes, right, work with patient James Deshur, of Bayside, at their Fox Point clinic, Dec. 12, 2013.


Maine’s health care world received a new dose of transparency on Jan. 1.

That’s when a new state law took effect requiring all health care practitioners to keep a list of the most frequently provided health care services and procedures and their prices. That means when you go to the doctor’s office, you can ask to see how much it might cost to get your blood drawn, your wart removed or to have your child examined.

This is a welcome change and comes after years of efforts to improve transparency of medical costs. In addition to the new law, Mainers seeking more information about the price of their health care could search the Maine Data Health Organization’s website, where users can find out how much certain procedures cost at different hospitals or compare by ZIP code. Or, for example, most insurers have a “ payment estimator” that allows members to find costs for procedures, doctor’s office visits, lab tests and surgery ahead of time.

The new law provides one more resource for patients or future patients. The price list must be available at providers’ offices, so people won’t necessarily have to search for the information online. And the prices listed — what people would pay if they had no insurance — are the simplest to understand. The ultimate cost for patients will depend on their particular insurance situation, but the lists provide a picture of the full price. They give a broader frame of reference, so patients can make more informed decisions about their health care, and so providers have an incentive to lower costs.

Now, consumers will have to use the price lists. They will also have to demand easier-to-decipher and readily available information about the value of procedures — which considers both price and quality.

It may not come as a surprise that few patients compare providers’ health care prices or look up costs before they go to the doctor. Catalyst for Payment Reform’s 2013 National Scorecard on Payment Reform, which was based on a national survey of health plans, found that while 98 percent of responding plans said they offer a cost calculator tool, only 2 percent of their members use them. Other studies have found varying use rates, but the fact remains that it can be tricky figuring out whether you’ll get high-quality care that is reasonable in price.

So doctor’s offices and hospitals will do well to publicize their price lists and make them easy to locate and use in person and online. Consumers might also be given a direct reason to act on the information; simply having data available is usually not enough.

Employers or insurers could use price data to develop incentives for consumers to seek better-value specialists or services. Change Healthcare, for example, rolled out a tool called Ways to Save Alerts, which are texts or emails that let a member know of a way to save money on his or her recurring medical purchases. In one case study, when 80 percent of employees received the alerts, 66 percent acted on them.

The legislation sponsored by Sen. Dick Woodbury, I-Yarmouth, that became law Jan. 1 introduces a little more transparency to Maine health care. For a long time, both insured and uninsured patients getting lab work done or seeking help at a hospital have had little idea about what the costs of their care would be. While health care cannot always be a consumer market, as patients do not have the training of doctors and knowledge about the scope of care necessary, there are many instances when cost information about procedures can be helpful.

Now patients will have to use the information, and employers, insurers and other groups that care about keeping health care costs low can provide incentives for patients to use that information along the way.

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