Most consumers living in a state with some of the most comprehensive healthcare price transparency laws have never thought to seek out pricing information for provider services, according to a recent survey.
About 54 percent of the 500 adults in Massachusetts surveyed for the Pioneer Institute said they never thought of trying to obtain price information about healthcare services. Additionally, the survey found that only one in five consumers had ever tried to find pricing information prior to obtaining the service.
Under Massachusetts law, providers must give consumers the price of any procedure within two business days, if requested. Hospitals must also disclose the allowed amount, or how much payers will reimburse the provider for a procedure
Additionally, the state also requires insurance carriers to provide consumers with out-of-pocket cost information in real-time through online cost estimator tools and via a toll-free telephone number.
The laws put Massachusetts in the top tier of quality of healthcare price transparency information, according to the Pioneer Institute. Additionally, its laws are similar to new healthcare price transparency regulations finalized by CMS on the national level.
However, a gap remains between the goals of healthcare price transparency laws, which include empowering patients to shop for high-quality, affordable healthcare services, and actual consumer behavior, the Boston-based think tank found.
“Consumers say they want price information, but only a small portion of people know they have access to it,” said Barbara Anthony, the report’s lead author and senior fellow in healthcare policy at the Pioneer Institute. “The gap between aspirations and the ability to actually obtain price information must be filled.”
In Massachusetts specifically, awareness was a major barrier to healthcare price transparency.
The survey, which comprises adults who obtained insurance through employers or on the open market in June 2019, showed that 70 percent of consumers did not know that their health insurance carriers had a cost estimator tool.
Additionally, 10 percent of consumers just did not know how to obtain provider pricing information and 15 percent believed prices would be the same regardless of which provider they went to.
The latter findings point to “a provider environment that does not prioritize providing price information to prospective patients,” stated Anthony and the report’s co-author Seher Chowdhury, a Pioneer research assistant in health policy.
Physician practices and hospital administrators should be trained to give consumers price information and help them navigate insurer cost estimator tools, the policy experts advised. Provider administrators should also prepare to give patients referrals to specialists or tests based on the prices of the services, they added.
Healthcare price transparency has been a pain point for providers, many of whom believe health insurers should be more responsible for delivering transparency since consumers need out-of-pocket cost estimates, not actual provider prices.
However, doctors were the second most cited source of trust for the best pricing information, according to the survey. Additionally, it was only second to health insurance carriers.
“Hence, doctors’ offices are in a good position to offer guidance and options when referrals are being made,” Anthony and Chowdhury stated.
Hospitals, however, have more room for improvement, considering just 3 percent of consumers said they trust hospitals to get the best pricing information.
Improving healthcare price transparency will require resources from providers, as hospitals have pointed out in comments on new national regulations. But those efforts could help bend the healthcare cost curve, the survey indicated.
Almost 70 percent of consumers favored physician and hospital websites that displayed how much a provider’s service could cost in out-of-pocket expenses. The option even outranked the option of getting cash back from an insurer for choosing a low-cost provider, which 66 percent of consumers said would help them select lower-cost care.
To provide pricing information that can reduce costs, though, providers and payers will need to collaborate in order to deliver out-of-pocket cost estimates in addition to the prices providers charge uninsured patients and payers for services.