Opinion: At last, a way to compare prices for hospital procedures

By Bob Semro

How much does a knee replacement cost? A Caesarean section? For years in Colorado, it was almost impossible to know.

Bob Semro

Bob Semro

In 2008, a group of Colorado health care and health insurance experts and advocates outlined a goal: Gather information about health care prices in a transparent, understandable way for Colorado consumers.

The goal was to help consumers make informed health care decisions. And by opening the books on price information, perhaps help to control costs.

Now, we have Colorado Medical Price Compare, which takes an important step in providing price information for Coloradans.

According to the website, unveiled last week, the cost of a knee replacement ranges from a low of $19,760 at Exempla Good Samaritan Hospital in Lafayette to a high of $58,338 at North Colorado Medical Center in Greeley.

That’s not a complete picture, however. At this early stage, full price data are not available for all of the listed hospitals. That means Front Range consumers will find a range of price information, but Western Slope residents may have to widen their search to find more hospitals with cost data.

But that will change as more price information is added to the database.

For now, a consumer can use the website to check prices for knee replacement, hip replacement, uncomplicated vaginal birth and a Caesarean section. Nine more services and ambulatory center prices (including knee arthroscopy and colonoscopies) will be added in November, and as many as 30 (including imaging services such as MRIs and CT scans) will be added in 2015.

Consumers also can check “hospital quality,” which includes mortality rates and infection rates for each procedure, and “patient perspective,” which has ratings for care by nurses and doctors, cleanliness, pain management and overall ratings for the hospital.

Here is some additional information about the database:

• Prices shown are for 2012. Prices for 2013 will be added in November.

• Price includes total payment to the hospital and doctor as well as fees for “ancillary” services such as lab tests or transportation.

• The database includes data for private insurance (individual and fully insured large-group plans) and Medicaid. It does not include small-group or self-funded plans or Medicare. (Small-group data will be included in the November update, and at some point, hospital-specific data for Medicare will be available.)

• Under state law, insurance carriers are required to submit claims data, and then hospitals have a period of time to review the data for accuracy. The vast majority of hospitals have reviewed and validated the data.

• Pricing information is not provided on the website unless a minimum number of procedures in a particular insurance category have been performed in a year. High and low prices in each category are thrown out as “outliers.”

Other websites might have some price information, but Colorado Medical Price Compare offers “actual payments made by health plans and patients,” according to the Center for Improving Value in Health Care (CIVHC).

CIVHC is the organization that grew out of the 2008 commitment to gather price information (a recommendation by the Colorado Blue Ribbon Commission on Health Care); it developed the website and administers the All Payer Claims Database, the source for pricing information.

This is the second phase in the development of data derived from the All Claims Payer Database. Here is a description of the first phase.

Bob Semro is a health care policy analyst with the Bell Policy Center, a non-partisan policy research center that advocates public policies that reflect progressive values. Joe Watt, communication director at the Bell Policy Center, contributed to this piece.

Opinions expressed in Health News Colorado represent the views of the individual authors.

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