The majority of American adults can’t afford an unexpected $400 expense, according to research from the Federal Reserve. That’s troubling, given that the price of a hospital service can vary by $400 or more from hospital to hospital – with no visibility into why.
That lack of transparency was the driving force behind the Hospital Price Transparency Rule that took effect this year. If you haven’t noticed much change in hospital pricing transparency, though, you’re not alone. Compliance is only around 70 percent right now, and the format hospitals are required to publish data in isn’t easily usable.
That’s where Healthcare Data Analytics comes in. Our B2B pricing transparency tool is designed specifically to compare costs from multiple hospitals and payers, at a glance.
The potential implications are significant: hospitals can find out where their prices are most or least competitive. This knowledge can fuel marketing, growth, and even patient care strategies.
On the public health side, more competitive prices for a shoppable service like a colon cancer screening could lead to more widespread testing, and thus translate to saved lives.
In this post, we offer a glimpse into the kinds of information our pricing transparency tool offers, plus some insight into how this information might influence decision making. Using price transparency data provided by hospitals, including important detailed negotiated rate information at the payer level, we focus on median hospital prices for four services. Each service is categorized by the popular charge, or Current Procedural Technology (CPT) code, part of the CMS Healthcare Common Procedure Coding System (HCPCS), at four Minnesota hospitals.
1: CPT Code 42820: Tonsillectomy Cost in Minnesota
Tonsillectomy cost varies considerably, even within Minnesota. As this shoppable service is rarely performed in emergency settings, tonsillectomy patients are especially well-positioned to compare prices to find the best value before the procedure.
Below are the median prices at three Minnesota hospitals:
The implications of these cost differences are striking.
Essentia Health is located in Coon Rapids, a suburb just outside of Minneapolis, where Abbott Northwestern is located. By driving 30 minutes, a typical Minneapolis resident could save more than $1,800 on this procedure, often even more, depending on the insurance carrier.
That’s an option many Minneapolis residents would likely take if they had access to this information – say, on billboards around the city. Of course, Essentia would have no sense of how powerful such a campaign could be for bringing in new patients without taking advantage of this pricing data, which is required by law to be publicly available.
2: CPT Code 45380: Colonoscopy Cost in Minnesota
Colorectal cancer is the second leading cause of cancer death among cancers found in both men and women. Early detection via colonoscopies has been shown to effectively decrease mortality rates from the disease.
Yet only about 67 percent of adults aged 50 to 75 keep up with the recommended screening once every 10 years.
While many people fear the pre-procedure cleansing process, concern over cost likely keeps away many more who need it: a Gallup poll found that 25 percent of Americans say they or a family member put off treatment for a serious medical condition because of the cost.
And because socioeconomic factors correlate with colon cancer risk, it’s clear that more affordable colonoscopies would lead to better health outcomes.
Here are the median prices at the same Minnesota hospitals cited above:
There’s a $600 median price difference between a colonoscopy at Abbott Northwestern and Mercy versus at Essentia Health.
That savings may make a profound difference in encouraging at-risk adults to receive a colonoscopy that may save their life – and also in bringing new patients to Abbott or Mercy.
3: CPT Code 55700: Prostate Biopsy Cost in Minnesota
A prostate biopsy is another critical cancer screening procedure for adults in the US. About one in eight men will get prostate cancer in their lifetime, and the disease is the second leading cause of death in men, second only to lung cancer.
Before a physician can make a prognosis, they have to perform a biopsy.
Below is the median price of a prostate biopsy at two Minnesota hospitals:
While this price range is closer to what true competitive pricing could look like, a $200 or more difference might be enough to draw patients to one provider over another.
4: CPT Code 59510: C-Section Cost in Minnesota
C-sections are recommended when it’s considered safer than vaginal delivery or medically required, but mothers can also request the procedure, making it a shoppable service.
C-sections have increased in frequency over time, which may be partly explained by the fact that doctors are paid more for the procedure than a standard vaginal birth, and C-sections typically cost about 50 percent more. Mothers who choose to undergo a C-section may not be aware of its potentially high cost when they make the decision.
Below are the median prices of a C-section at two hospitals in Minnesota:
Community Memorial Hospital is located in Cloquet, MN, outside Duluth, which may explain why the price of a C-section is 33 percent lower than the price at Minneapolis-based Abbott Northwestern.
Abbott’s location may partly justify its higher cost. Knowing that patients would have to drive two-plus hours for a cheaper alternative is a valuable data point as it negotiates rates with an eye on profitability.
Price Transparency Drives Better Outcomes for Hospitals and Patients
Equipped with these median prices for common services, as well as the detailed negotiated rates by payer, hospitals can make pricing decisions that make their treatment options more competitive and, crucially, understand how to position themselves to attract and retain customers.
If you’re interested in viewing your hospital’s or your competitors’ data, contact us today to set up a free trial.