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Startling Differences in New-Hip Estimates: Study

By Alan Mozes
HealthDay Reporter

MONDAY, Feb.11 (HealthDay News) -- Advance estimates for a standard hip replacement at a top-ranked U.S. hospital can run as low as $12,500 or surpass $105,000, if you can actually obtain a quote, a new study finds.

Many hospitals can't -- or won't -- provide straightforward price quotes in advance of medical procedures, the researchers found. And when they do supply estimates, the costs see-saw widely, even between comparable facilities, they said. For instance, at general hospitals they found a nearly $115,000 differential for a new hip, with total fees from $11,100 to about $126,000.

"On the quality front, there's actually a lot of data available," noted study co-author Dr. Peter Cram, an associate professor and director of the division of general medicine at the University of Iowa Carver College of Medicine in Iowa City. "Information and assessments are everywhere. And generally that's a good thing," he said.

"But it turns out that price data is much, much, much more limited," he added. "Which is funny, because measuring quality is really hard, and relatively speaking, pricing information should be much easier to get."

For the study, published online Feb. 11 in JAMA Internal Medicine, the authors randomly selected 122 medical centers -- two non-ranked hospitals from all 50 states plus Washington, D.C., and another 20 orthopedic hospitals that were "top-ranked" by U.S. News and World Report.

Between 2011 and 2012, all the facilities were requested to provide the lowest total (or "bundled") hospital-plus-doctor price for a patient described as a 62-year-old grandmother who lacked insurance but had the means to pay for the elective service out-of-pocket.

After contacting each hospital a maximum of five times, the team found that only 10 percent of the non-top-ranked hospitals and 45 percent of the top-ranked orthopedic group hospitals could name their price. Spread over all 122 facilities, that equaled a success rate of just 16 percent.

However, when the team expanded their effort by contacting both the hospital and the relevant health care providers, they were able to up the success rate to north of 60 percent.

"From the glass half-full perspective, we found that with some hard work and incredible perseverance we were able to get a full price for service from about 60 percent of hospitals," Cram said. "That's if you include both prestigious orthopedic institutions and general hospitals."

That means that much of the time people can do this, he added.

"They can actually shop around just like the way you would for a Honda Civic," Cram said. "And I would say that since we're talking about your health, the effort is worth it."

But from the "glass half-empty perspective, for people who have limited health literacy, limited time, or are non-English-speaking, this process could be extremely daunting," acknowledged Cram.

What was striking was how ill-prepared hospitals were for their call, he said. "You get transferred from one person to another, and you get hung up on a lot . . . or you just don't get called back at all," he said.

That's because the insurance system is set up so patients don't negotiate prices, he noted. "The price most of us pay for our health care is hidden behind a veil, and varies enormously from place to place and for person to person for the exact same service depending on your coverage."

It's important that patients start pushing for this information, "because otherwise we're just giving hospitals a pass," he added.

Dr. Ezekiel Emanuel, co-author of an accompanying editorial and chairman of the department of medical ethics and health policy at the University of Pennsylvania in Philadelphia, expressed little surprise with the findings.

"The idea that not everyone can provide pricing reflects one of the deep problems with our system," he said. "But even if we could get prices easily, that won't be the whole story, because you need to have price and quality metrics together. Otherwise, you could find a cheap price for a crappy job."

Emanuel said the desired endpoint is the combination of low price and high quality. "That's the sweet spot we're all looking for," he said, "and that is a very tricky spot to find."

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SOURCES: Peter Cram, M.D., M.B.A., associate professor, and director, division of general medicine, department of medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Ezekiel J. Emanuel, M.D., Ph.D., chairman, department of medical ethics and health policy, University of Pennsylvania, Philadelphia; Feb. 11, 2013, JAMA Internal Medicine, online

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