Same Procedure, Different Cost: Prices Vary At Ohio Hospitals

CLEVELAND — Depending on what hospital a patient in Ohio goes to, prices for the same procedure can vary widely, a new study found.

The Center for Community Solutions surveyed Ohio's 206 hospitals and found there is no consistent relationship between price, hospital type and common medical procedures. And a newly mandated price transparency measure is not having the effect lawmakers hoped, the study found.

In June 2019, President Donald Trump ordered the "chargemaster" portion of the Affordable Care Act to be enforced.

The chargemaster is a standardized file, available online, aggregating a hospital's prices for various procedures. The study found many Ohio hospitals do not yet have a chargemaster available to the public. Hospital systems have until January 2021 to implement a consumer-friendly chargemaster.

“Prices for common procedures vary greatly and are not readily available or in a plain language format; they should be,” said John Corlett, president and executive director of Community Solutions. “This is an area where both state and federal policy action is needed to protect consumers who expect to receive a quality service at a fair price when they need it most.”

The six procedures examined in the study are:

• Inpatient Appendectomy
• Inpatient Bypass Surgery
• Angioplasty
• Total Joint Replacement
• Cesarean sections
• Labor and delivery without induction, complications, etc. (i.e. Normal Delivery)

"We found vast price differences from hospital to hospital. Of the procedures we compared, inpatient bypass surgery had the range in price – with more than $200,000 between the highest and lowest prices for that procedure," Loren Anthes, the author of the study, wrote.

The study found that Ohio's hospital prices for inpatient appendectomies, for example, are two times higher than the national average. Ohio's average inpatient appendectomy costs $31,669, while the U.S.'s average procedure costs $15,155.

Similar price discrepancies were found for inpatient bypass surgeries, angioplasty, total joint replacement, and birthing procedures.

Locally, major hospital systems are implementing new policies to improve pricing transparency on procedures. University Hospitals, for instance, is launching an online self-service "Hospital Price Estimator" this year. The tool will provide an estimate for out-of-pocket costs at UH hospitals for 300 highly utilized procedures. The tool will evaluate a patient's health insurance plan, deductible, co-insurance and co-pay.

"The tool also provides uninsured patients with cost for care and includes links to our Financial Counseling services and help with other options such as insurance coverage, financial assistance and associated discounts. We continue to focus on providing our patients with information in advance of care in order to make the best choices about their health care needs," a University Hospitals spokesperson told Patch.

The Cleveland Clinic has been providing pricing estimates for care to patients since 2016, a spokesperson said. The hospital system has also updated its self-service module, which allows patients to produce their own pricing estimates.

A Cleveland Clinic spokesperson said the hospital system has complied with all CMS requirements by posting its comprehensive hospital charges on its website. Like Anthes, the spokesperson noted that the listed charges are rarely what a patient pays.

"Hospital charges are based on numerous factors including national benchmarks, local market pricing, internal costs and differences in care needed by each patient. Our prices are in alignment with the national average for larger diagnostic centers," the Cleveland Clinic spokesperson said.

Anthes was quick to note that hospitals are not the key to fixing the system.

"This is not a hospital problem. Hospitals are important anchor institutions. They support economies. We are very fortunate to have the network of systems that we do in our state and in Greater Cleveland," he said.

Improving Cost and Care

Increased price transparency isn't necessarily going to fix a largely broken system, Anthes told Patch.

"This information is not changing patient behavior. List prices don’t actually reflect what’s paid. It’s often a negotiation between insurers and hospitals. Patients are not directly interceding in that. Patients don’t make comparisons on these procedures," he said.

Instead, Anthes would like to see increased investment in preventative programs. That means investing in public transportation, physical therapy, healthy meal programs and more. He also argues that Ohio should create an oversight committee, prevent healthcare industries from regulating themselves and explore creating a state plan for Ohioans.

"We do need to do everything we can to protect consumers. I don’t want to see people lose coverage, and I don't want to see hospitals closed, etc.," he said.

The full study has been shared online.