Patient Knowledge of Procedure Price Variations Lowers Cost

Ricki Lewis, PhD

October 26, 2016

Patients who know the price of an upcoming medical procedure at different healthcare facilities often choose lower cost facilities, even if they do not share in the savings, according to a study published online October 24 in JAMA Internal Medicine.

The same medical procedure can vary widely in cost at different healthcare facilities, even in the same geographic location. Studies have shown that patients choose lower-cost advanced imaging services and certain laboratory tests when both the patients and their commercial insurers benefit from the savings, but those studies did not examine choice of lower-cost options when patients do not share in savings.

Anna D. Sinaiko, PhD, MPP, a research scientist in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health in Boston, Massachusetts, and colleagues analyzed the effect of a price transparency tool on facility choice among Aetna commercial insurance enrollees.

The company offers the tool to 94% of its commercial enrollees, according to the authors. Of these, 3.5% (181,563) used the tool between 2010 and 2012 to check on the cost of one of the services included in the study: echocardiogram, carpal tunnel release, cataract removal, mammogram, colonoscopy, sleep studies, upper endoscopy, and magnetic resonance imaging and computed tomographic imaging services.

The researchers compared whether patients who consulted the tool to learn the prices of their upcoming procedures at different facilities were more likely to choose cheaper options than another group of patients who either underwent any of the eight procedures before the tool was available to them (early in 2010) or who used the tool to research procedures other than the designated eight.

Patients chose lower-priced facilities after learning price estimates for imaging services (price estimate in the 46th percentile for the market vs 54th percentile by the comparison groups; P < .001) and for sleep studies (price estimate in the 42nd vs 47th percentile; P = .001). Considering pricing was associated with lower adjusted total spending ($131.40 [12%; P < .001] for imaging and $103.50 [6%; P = .06] for sleep studies).

The researchers conclude, "Among early adopters, those searching for prices on imaging services and sleep studies chose health care facilities with lower prices and incurred lower spending for imaging studies." However, they note the low use of the tool.

Limitations of the investigation include reliance on one insurance carrier, consideration of data corresponding to only the first 2 years of implementation of the price transparency tool, and assuming that patients sought price information for comparison shopping purposes.

The researchers have disclosed no relevant financial relationships.

JAMA Intern Med. Published online October 24, 2016. Full text

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