A new tool to make notoriously opaque health care prices more transparent shows huge cost disparities among the state’s health care organizations.
Thank you Federal Hospital for the price Transparency Act Effective in 2021, Granite Staters will now be able to compare prices for common procedures based on their insurance plans. Among other things, its purpose is to help patients save money.
As required by the new law, most New Hampshire hospitals have a public list of common medical procedures and corresponding costs negotiated with insurance companies. Advocates hope transparent pricing will draw attention to areas where medical procedures are overpriced.
Prices for a plan’s standard program can fluctuate widely across the state and even within similar geographic areas.
Still, the new effort on transparency has its limits. Comparing the exact same procedures between different facilities can be tricky.
At Elliott Hospital, for example, a catheter into the heart “for recording, pacing, and attempting to induce abnormal heart rhythms” costs $9,445. However, Elliott did not account for differences in insurance plans, which can vary widely. At Concord Hospital, the cost of catheterizing the heart for diagnosis was $15,041 for Blue Cross patients and $3,842 for Ambetter patients.
Healthcare prices can vary even within the same healthcare system, according to pricing data reviewed by the government monitor.
Emergency room costs for moderately complex conditions, such as mild asthma or head injuries, vary by hundreds of dollars between Concord Hospital’s various locations in Concord, Laconia, and Franklin.
Currently, the average cost of a low-level emergency room visit in Concord is higher than in Franklin or Laconia. Likewise, when comparing median negotiated prices, Concord’s insurers charge about twice as much for brain MRIs as Laconia and Franklin do for the same procedures.
The cost of a vasectomy at Concord was nearly double ($758) the median cost ($392) at Laconia and Franklin.
Concord Hospital acquired LRG Heathcare from bankruptcy in 2021 and is working to make costs more consistent across facilities.
“Our goal is to eventually have a consistent total charge for all three hospitals at the same cost. The process is not yet in place,” said Erin Cutter, director of revenue integrity at Concord Hospitals. “Having said that, in many cases it is not appropriate to provide consistent pricing due to the multitude of variables.”
Xie He Hospital Cost Estimator Allows patients to compare prices based on procedure codes and insurance plans.
Experts say a number of factors affect commercial reimbursement rates, including procedure time, equipment costs, supplies and services, and the acuity and complexity of the patients being served. In other words, estimated and actual costs can vary widely.
Higher prices are almost always passed on to patients, said Dr. Elliot Fisher, a Dartmouth researcher who studies health care spending.
“All of that is either passed on through the price they pay through a high-deductible health plan because they have to pay the first five or ten thousand dollars,” he said. “Otherwise, it’s included in their premiums.”
Patients insured through their employers are often still struggling with rising medical costs, Fisher said. several health economists It has been found that when health care costs rise, employers often increase employee premiums or cut benefits.
Fishing around for the best deals in the routine process can save individuals and keep prices down, Fisher said. But this is not always practical, especially in an emergency or emergency.
Some researchers found that these transparency initiatives were successful—a study New Hampshire’s statewide transparency database was found to reduce patient costs for medical imaging procedures, such as MRIs and X-rays, by 3 percent over five years.
Price transparency and price comparison tools can help consumers find lower-cost alternatives, but greater systemic pressure is needed to reduce costs and improve accessibility, said Lucy Hodder, director of health law and policy at UNH’s Franklin Pierce School of Law.
“We have no responsibility anywhere in the system to actually reward or drive value,” she said.
Rising health care prices are placing a growing burden on Granite Staters.
A sort of 2021 report Data from the New Hampshire Department of Insurance shows that Granite Staters consistently pay higher average health insurance premiums than the national average and the average for most New England states.
The same report also found that the average deductible in the Granite state is significantly higher than the U.S. average.
These higher-than-average costs can be attributed to a number of factors: New Hampshire is a small state, which means the industry’s big bills — like a new cancer center or an expensive new miracle drug — are allocated to a relatively small state. Small groups, making it more expensive for everyone.
The state has also undergone several hospital mergers in recent years, which have brought hospitals together with insurers and has been shown thereby increasing the price.
Hodder said high prices affected people’s ability to access health care.
one National survey It was found that in the months leading up to October 2021, one in three Americans forgoes care because of costs.
“The rising health care costs in New Hampshire are dramatically impacting families and businesses,” Hodder said. “I think our suppliers are trying to figure out how to manage it.”