A doctor’s prescription: Be more open about health-care costs

Rising health-care costs might be more manageable if selecting the provider for a procedure was a bit more like shopping for groceries, according to one Fitchburg doctor.

When shoppers roll their carts through a supermarket, every price is listed — bananas: 39 cents a pound, a single serving of yogurt: 49 cents — well before the checkout.

But when a patient needs an MRI, a procedure that can be over a thousand times more expensive, the price often isn’t accessible or consistent, said Dr. Knute Alfredson, who runs a practice on Main Street.

Alfredson submitted a proposal for a ballot initiative to the state attorney general this summer that he says would make it easier for patients to compare prices on certain medical procedures.

“Consumers are not demanding to know the prices of medical services,” Alfredson said. “Are providers tempted to charge more because consumers do not ask the the prices before buying? Of course.”

The proposal would require providers of radiology and imaging procedures to post a link to prices on their website’s homepage. Eligible procedures include mammograms, CT scans, MRIs, PET scans, nuclear medicine imaging and ultrasounds.

Failure to include the link with rates for both insured and uninsured patients could, after several warnings, result in the provider’s license being suspended or revoked, according to the petition.

The proposal comes in the wake of academic and media attention to the cost of medical procedures, which often varies widely among providers.

A March article from the USA TODAY Network reported as much as a $3,200 gap in some states between the median price for MRIs at hospitals and the price at free-standing imaging centers.

In 2016, the Pioneer Institute conducted a survey of 21 Massachusetts hospitals where callers asked for a quote on one type of procedure: an MRI of the left knee without contrast. The undiscounted price ranged from $1,061 to $8,447 with Massachusetts General Hospital in Boston providing the highest quote and Morton Hospital and Medical Center the lowest.

In Worcester, UMass Memorial Medical Center quoted the caller $2,833, undiscounted, or $2,266 if applying the discount provided to patients not using insurance. Saint Vincent Hospital, also in Worcester, offered a discounted price of $2,236.

Though Alfredson said his ballot initiative proposal may be the first of its kind nationwide, a different law with similar goals is already on the books in Massachusetts.

But the same Pioneer Institute study found not all hospitals are in compliance with this law passed in 2012, which requires hospitals, physicians and clinics to provide prices for medical procedures within 48 hours of the request. Of the 21 hospitals surveyed, nine responded within 48 hours or less, according to the report.

Even with this law, Alfredson said many never ask, possibly because there’s a level of trust between patients and health care providers, possibly because they don’t know the price of MRIs, and even medications, can vary.

“They think that the price is fixed, but the price is variable just like automobile prices from dealer to dealer,” he said. “This is an educational process for people living in Massachusetts. They have got to start asking.”

At his own practice, patients don’t ask either.

“People never ask what I charge,” he said. “They feel it would be an insult. I can’t explain it.”

Ed Roth is a program assistant at the SHINE Program, Serving the Health Insurance Needs of Everyone. The statewide program sends representative to the Fitchburg Senior Center every other week to answer health insurance questions and sign people up for Medicare and Medicaid.

Roth said throughout the state his staff encounters confusion about health care options.

“They don’t know anything about it,” he said. “They have no idea. … It’s absolutely a very confusing process for people.”

Roth was not familiar with the proposed ballot initiative but said more information is generally beneficial for the consumer.

However, some people may not be asking about pricing, because they have health insurance that offers a fixed co-pay for these procedures, he said.

“They don’t care as long as it’s covered by insurance,” he said. 

Alfredson argues this is a false security that ultimately drives up insurance premiums and deductibles, affecting the consumer.

He said he sees patients with $2,000 deductibles that forgo testing because of the price and others that lose health insurance when they lose their jobs.

Currently, proponents of the initiative are waiting for the attorney general’s office to approve the constitutionality of the measure, which Alfredson said he doesn’t expect to be an issue, because supermarkets follow a similar law about posting prices.

From there the initiative needs 65,000 signatures to get certified for the 2018 ballot.

Alfredson does not offer radiology procedures at his practice, and none of the roughly 20 people on the committee promoting the initiative are in the field, he said. Most committee members are consumers, according to Alfredson, who added he believes the ballot initiative may not be popular among hospitals.

Michael Sroczynski — vice president for government advocacy at the Massachusetts Hospital Association — said in a statement that while the hospital community has been working to improve price transparency, the information called for by the petition may be confusing for consumers.

“On initial review, this petition appears to require a standard that would only further confuse patients by requiring a posting of information that has no relation to the price that will be paid for the service,” he said in an emailed statement.

“The position we ultimately take on the petition is contingent on whether the sought-after mandate actually enhances patient knowledge of service costs without compromising what the state has already achieved in providing meaningful cost information to patients.”

Several hospitals in Northern Central Massachusetts and Greater Lowell area did not return a request for comment.

Alfredson said he sees this initiative as the first move toward providing information to patients. The initiative focuses on radiology, but he said there is room for more transparency in pricing in other areas of the medical field.

“We want to just take the first step and get a public discussion going,” he said.


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