As more and more patients try to shop for health care, it puts hospitals in a tough spot.
When patients ask for the price of their care, they run into the indecipherable system of charges hospitals have developed over the years in contract negotiations with health insurers. But real hospital prices—the ones negotiated with insurers—remain hidden from the public because the insurers demand it and hospitals don’t object.
On top of that, hospitals have not come to common agreement on a simple way to measure quality.
In spite of those challenges, the Indiana Hospital Association is pushing ahead with a new web tool to give Hoosier patients’ price and quality information about the more than 165 hospitals around the state.
The web site, known as CareINSight, went live last week, although it won’t be officially kicked off until next week. It is located at mycareinsight.org.
CareINSight leads off with a surprisingly candid video titled “Why does health care cost so much?” and then guides consumers through an easy-to-use tool to find and compare hospital prices for the 100 most common inpatient procedures.
It also presents quality information in a handy format in four key areas: infection rates, mortality rates, readmissions rates and levels of patient satisfaction. Those data come from the federal Medicare program's Hospital Compare web site, but are put in a visual form that is easy to understand.
CareINSight does not include any outpatient procedures, which is any health care service that does not require an overnight stay in a hospital.
Doug Leonard, the president of the Indiana Hospital Association, said the web site doesn’t have everything consumers will want as they shop for care, but he hopes it can be updated as better price and quality information becomes available.
“It’s not perfect, but it’s a big step in the right direction,” Leonard said. “This site will keep evolving.”
Leonard, a former CEO of Columbus Regional Hospital, described the site as “another pressure point” pushing hospitals—as well as employers and even the state government—to give patients the information they need to make the kind of rational buying decisions they can make in nearly all other areas of the economy.
The first pressure point was the Great Recession, which caused unemployment to spike, and made all health care consumers more price conscious, Leonard said.
But even as the economy is growing rapidly again, consumers are getting even more financial skin in the game. The prevalence of high-deductible health plans at U.S. employers has quadrupled to more than 40 percent in the past eight years, according to an annual survey by the Kaiser Family Foundation.
That trend is certain to continue, as employers try to keep the cost of their health plans low enough to avoid a 40 percent excise tax, created by Obamacare, which will start in 2018.
Deductibles were already sky-high among consumers that bought insurance on their own, but the number of people covered by such plans is going up because Obamacare offers tax credits to reduce the cost of those plans and also tax penalties for most Americans if they fail to obtain health coverage.
“Hospitals are increasingly going to have to answer these questions” from consumers, Leonard said.
Various groups have tried to step in to give consumers the information they want. Health insurers like Anthem Blue Cross and Blue Shield and UnitedHealthcare have created tools to compare the cost and quality of health care services.
Employers have turned to such web tools as Castlight and Healthcare Bluebook to give their workers information on health care prices.
The Obama administration has also released data on what Medicare—the federal health insurance program for seniors—pays hospitals and physicians.
The Indiana Hospital Association considered using Medicare data for its CareINSight tool, but then changed course, because it wanted to include health care services that seniors don’t receive—such as childbirth care.
The only publicly available source of prices for all Indiana hospitals is the chargemaster list of sticker prices that each hospital is required to report to the Indiana State Department of Health. So that’s what the Indiana Hospital Association used on its new web site.
Leonard spoke hopefully about the Indiana General Assembly creating an all-payer claims database, which would collect information from health insurers, third-party administrators and other entities that process medical bills. That would make real prices available in a public format.
As of 2013, 14 states either had or were implementing an all-payer claims database.
In the meantime, he said, he hopes individual hospitals clean up their chargemasters so they better reflect what consumers will actually pay for health care services. He also hopes they build more consumer-friendly web sites and phone services to help patients shop for care.
“Hospitals,” Leonard predicted, “are going to get better at this.”