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By Mark Salamon, February 1, 2021

Over the last twenty-five years as a physical therapist I have had to answer some very difficult clinical questions, and by far the toughest so far has been, “This brace is not covered by my insurance, how much is it if I just want to buy it?” 

As a clinician who wants to be able to solve every problem, this question made my heart sink. I had to explain that while modern medicine has made amazing strides, there are still things we just don’t understand, and this is one of them. I could not, in good conscience, give false hope, but I said I would try. 

So I called the rep and spent forty-five minutes playing a fun-filled game of “try to get me to name the price.” I was doing pretty well, and for a brief moment thought that I was on the verge of solving one of the great medical mysteries of all time. But the rep stole the victory because to get to the final level I would have had to attend a seminar and listen to a presentation about a timeshare in Florida.  

This difficulty stems from the fact that the medical industry models its pricing system on that of the airline industry, which takes into account things like gas prices, customer demand, weather patterns, seat availability, time of year, political unrest, unemployment numbers, and your personal Facebook status. These numbers are crunched using a supercomputer, and the results are then filed away somewhere while they use one of those lottery machines with ping-pong balls blowing around like popcorn to pick a random number that is used as that day’s price.

If you are lucky enough to not have to work or do anything else besides pour through hospital websites while you are on hold with their billing departments, you may be able to find out how much some hospitals charge for various procedures. But these prices have absolutely nothing to do with how much insurance companies actually pay. They are just a useful tool that hospitals use to get patients who are trying to compare costs to stop tying up their phone lines.

But these hospitals are now in a panic because of a new federal price transparency rule that went into effect on January 1, 2021, requiring them to post what they are actually paid for services. The American Hospital Association, which goes by the creative name “AHA,” is understandably upset, and is fighting back with arguments like it would be much too expensive to implement and “posting such prices can be confusing to patients and harm the marketplace.” Lucky for us, the government is having none of it, and is directing these hospitals to just suck it up and have one of their college interns post their damn prices like everybody else.

This ruling will hopefully make life a lot easier for patients who want to compare cost and quality, something that up until now has been next to impossible. As recently as 2018, a study out of Duke University and published in JAMA Internal Medicine showed that only 17% of websites offered any information that was remotely related to price, and when they did, the range of prices made the information practically useless. For example, in Chicago, “endoscopy prices ranged from $875 to $3958, brain MRIs from $230 to $1950, cholesterol panels from $25 to $100, and hip replacements from $27000 to $80671.” 

Reactions to that study were mixed. Some, like Dr. Karandeep Singh from the University of Michigan in Ann Arbor, seemed content with the “money is no object” approach, stating, “Cost isn’t necessarily going to be the the main factor driving patient’s decisions about health care…often, patients will decide to go for care based on which providers are in-network with their insurance, and this might not always include the highest-quality or most affordable providers.” Others, however, like lead author Dr. Peter Ubel, suggested that the results may in fact point to a situation that should be dealt with, and that “there is substantial room for improvement in providing customers with ready access to health care prices online.” This bold statement earned him an immediate nomination for the 2018 “Let’s Try To Be A Little Less Like Car Dealerships In Medicine” award.

Hopefully this new rule leads to meaningful change, because as things are now, I would still rather haggle with ten used car salesmen than try to figure out one more medical bill.