Progress on the long road to imaging exam cost transparency

por Lauren Dubinsky, Senior Reporter | February 14, 2018
Health IT Insurance MRI
HealthCost app
A lower back MR exam without contrast costs $172 at Inspira Women’s Imaging Center in New Jersey, but $7,646 at Torrance Memorial Medical Center in California, according to Clear Health Costs — a website that lists the costs of medical procedures by zip code.

“Consumers aren't always aware of the vast differences,” Bruce Carlson, publisher at Kalorama Information, told HCB News. “There is a move toward transparency and I'd expect [that to] increase in the future.”

Patients have become increasingly involved in health care decisions in recent years. They browse the Internet for the best physicians and insurance plans — much like they would when purchasing a product.
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They are now able to do the same for medical procedures, thanks to websites like Clear Health Costs and apps like HealthCost. In May, HealthCost added more than 300 imaging procedures to its list of searchable data, including breast exams and cardiac ultrasounds.

The company sources its data from publicly available information provided by CMS. They took all of that big data, which is not easily accessible or understood, and channeled it into a user-friendly, free-market solution.

Healthx Inc. partnered with Change Healthcare last month to offer procedure cost transparency tools within Healthx’s member portal and mobile solutions. True View Select provides localized cost ranges by provider and procedure on a region-specific level, and True View Plus allows members to search for procedures based on their benefit plan.

“Members have a much bigger financial stake in the cost of their medical procedures today than ever before, due to higher deductibles, the increasing prevalence of HSA plans, and benefit plans tied to multitiered provider networks,” Mike Gordon, chief strategy and alliances officer for Healthx, told HCB News.

Change Healthcare uses retrospective claims analytics and the member’s accumulator data (provided by Healthx) to derive an accurate member out-of-pocket cost without requiring core administration system’s claims adjudication logic.

“Historically, medical procedure pricing has been elusive because payers are often protective and secretive of their negotiated provider network discounts, but also because the complexity of the claims adjudication process makes it difficult to accurately project the member's out-of-pocket cost in advance of actually adjudicating the claim,” said Gordon.

Kalorama’s Carlson points out that shopping for medical procedures is not the same as comparing two items at a grocery store. There is a staff and institution behind those procedures and the level of expertise is often factored into the cost.

“Behind that increased MR cost may be an advanced medical professional or a better system,” he said. “That doesn't mean everyone will agree with it. I do expect more downward pressure on pricing moving forward.”

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