Physician who researches price transparency at Harvard: My experience price shopping for care was terrible

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Ateev Mehrotra, MD, an associate professor of healthcare policy and medicine at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center in Boston, used one word to describe how his experience price shopping for care went — terribly.

Dr. Mehrotra detailed his experience in a recent opinion piece in STAT. He, like many other Americans, has a high-deductible health plan, which meant paying the entire cost out-of-pocket to have a stye on his daughter's eyelid remove. He wanted to compare prices for the procedure, and he began the price shopping process with several advantages: He lives in Massachusetts, which has price transparency laws; he's a physician; he has researched price transparency and consumerism; and he had a lot of time to shop around because the surgery was not urgent.

However, the process did not go as smoothly as expected. His insurer's price transparency page was hard to find and did not include the information he needed, and the billing department for the ophthalmologist who evaluated his daughter did not know the fees for the operating room or the anesthesiologist. Other ophthalmologists said they would need to evaluate his daughter to provide a price quote, and each evaluation would cost in excess of $200, according to Dr. Mehrotra.

Still searching for a better estimate, Dr. Mehrotra called his health plan. The insurer asked for a written cost request from the surgeon and hospital being considered to perform the procedure. Twenty-four days after submitting the cost request, the insurer provided an estimate that was incomplete and incorrect.

One-month into the price shopping process Dr. Mehrotra had little information about the total cost of his daughter's procedure. He had the ophthalmologist who originally evaluated his daughter perform the surgery, even though the total cost of the procedure was unknown.

"Sadly, my family's price-shopping experience is the norm in the U.S. My colleagues and I have found that most people can't successfully shop for care, and that offering people a price transparency website doesn't help them switch to lower-cost providers and doesn't decrease health care spending," Dr. Mehrotra wrote.

He made the following four recommendations to improve the process:

1. Bundle payments to hospitals and surgery centers to simplify billing.

2. Require healthcare providers to give cost estimates as soon as a procedure is recommended.

3. Make it easier to access price data.

4. Help patients profile primary care physicians based on the prices of tests they order and specialists they recommend patients to.

Read Dr. Mehrotra's full opinion piece here.

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