Saturday, November 17, 2018
Health

Big swings in medical prices make for a wild market, but savvy patients can benefit

An MRI can cost $413 in the Tampa Bay area.

It can also cost $2,566, depending on where you have it done.

The whopping $2,153 price difference is one example of how health care costs can vary dramatically within the same region, according to a new analysis by the health care information technology company Castlight Health.

The swings can be even more wild from city to city and state to state. In Pensacola, for example, an MRI of the lower back can cost as much as $5,546. Some providers in Utica, N.Y., however, offer the procedure for just $213.

"It is a chaotic landscape, which is why it is so difficult for consumers and employers to navigate," said Castlight vice president Kristin Torres Mowat.

So what gives?

For one, the market for health care doesn't behave like most other markets. Consumers usually don't know how much a procedure costs until after they've had it, and it can be challenging to compare prices beforehand. That means providers can set their rates somewhat independently of normal market forces — the forces that keep prices consistent at neighboring gas stations.

"It's hard to find a market that deviates more from the perfectly competitive structure," said Bruce Vogel, an associate professor of health policy at the University of Florida.

There are theories that can help explain the discrepancies between cities. For example, some procedures — but not all — cost more in metropolitan areas because the overhead costs are higher.

But how do you explain the variance in a single region?

A 2014 study published in the journal Health Affairs found that hospitals with strong reputations or a large share of the market tend to charge higher prices.

Prices can also vary based on the type of facility you choose. An MRI or CT scan, for example, can cost more at a hospital than a radiology center or outpatient center because the hospital has more overhead costs. Some hospitals may also pass along the costs of treating uninsured patients.

The Castlight analysis isn't the first to point out fluctuations. Vogel said the trend has long been driving a conversation about paying providers based on outcomes instead of services.

In the meantime, there is some good news for consumers. The wide price swings provide an opportunity to shop around in nonemergency situations.

"If you know you are going to be planning for a procedure — something like an MRI or a joint replacement — you should treat it like you are shopping for a car," said Kate Mezzanotte, a health analyst for the financial education website NerdWallet. "You should try to uncover the different prices that are available to you."

Tips on how to get the best prices:

Do your homework. Plenty of online resources can give you an idea of how much a procedure should cost. Among them: NerdWallet Health's Best Hospitals tool (nerdwallet.com/health/hospitals) and the site ClearHealthCosts.com. The state Agency for Health Care Administration also publishes price ranges at floridahealthfinder.gov.

Remember, though, high cost doesn't always mean high quality. Research outcomes and patient satisfaction, too.

Pick the right facility. You can sometimes save money by going to an outpatient clinic or imaging facility instead of a traditional hospital. The strategy may not make sense, though, if you are at risk of complications.

Ask for the price before the procedure. Don't be afraid to talk cost with your provider. The subject isn't taboo these days because most patients must meet high deductibles and share a portion of the costs.

"Patients can no longer be passive," Mezzanotte said. "They have to stand up for themselves as consumers."

Negotiate. If you have health insurance, your insurer has negotiated a rate with the provider. But if you are willing to pay cash — and not go through insurance — you may be able to get a deeper discount. Providers typically like the idea of getting their money up front rather than going through the normal claims process, which can take months.

"I always tell people, try to get the cash rate before you even say you have insurance," said Michelle Katz, a national health care advocate and author of the book Healthcare Made Easy.

Katz also recommends telling the provider if you've seen a better price elsewhere.

"If you tell them how much (another provider) is charging down the block, they may beat the price," she said.

Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

Comments
‘I believe you’: The culture around sexual assault is changing.

‘I believe you’: The culture around sexual assault is changing.

It has been a year of upheaval over sexual harassment and assault - from the #MeToo movement, to the confirmation hearings for Supreme Court Justice Brett Kavanaugh, more women are speaking out.
Published: 11/16/18
Inside the newsroom: Tampa Bay Times project team takes a deep dive inside a notorious Florida death penalty case

Inside the newsroom: Tampa Bay Times project team takes a deep dive inside a notorious Florida death penalty case

A project team at the Tampa Bay Times explores the death penalty in Florida through a notorious 1975 murder case.
Published: 11/16/18
FDA plan would ban menthol cigarettes, crack down on flavored cigars and vapes

FDA plan would ban menthol cigarettes, crack down on flavored cigars and vapes

A top U.S. health official is pledging to try to ban menthol from regular cigarettes, outlaw flavors in all cigars and tighten rules regarding the sale of most flavored versions of e-cigarettes.
Published: 11/15/18
Tampa General Hospital resumes normal surgery schedule after issue with instruments

Tampa General Hospital resumes normal surgery schedule after issue with instruments

After rescheduling some surgeries last week due to an issue with surgical instruments, Tampa General Hospital has returned to a normal schedule.Hospital staff discovered a slight discoloration on the cleaned and sterilized surgical tools last week du...
Published: 11/12/18
Some red states just voted to expand Medicaid. Could Florida be next?

Some red states just voted to expand Medicaid. Could Florida be next?

Medicaid — which has been a political football between Washington and state capitols during the past decade — scored big in Tuesday’s election.Following the vote, nearly 500,000 uninsured adults in five states are poised to gain Medicaid coverage und...
Published: 11/09/18
Why are we suddenly hearing about hepatitis A outbreaks? Experts blame the opioid crisis.

Why are we suddenly hearing about hepatitis A outbreaks? Experts blame the opioid crisis.

In just the last two weeks, one restaurant in Tampa Bay has shut down and another closed temporarily after outbreaks of hepatitis A. Health officials in Hillsborough and Pinellas counties say reports of the virus are way up, and they worry that more ...
Published: 11/08/18
Updated: 11/09/18
Issue with surgical instruments prompts Tampa General Hospital to cancel procedures

Issue with surgical instruments prompts Tampa General Hospital to cancel procedures

Tampa General Hospital is rescheduling a number of elective surgeries this week over an issue that caused some discoloration in surgical instruments. The problem surfaced during routine quality checks of surgical instruments performed prior to surger...
Published: 11/07/18
Updated: 11/08/18
Florida surgeon removes healthy kidney he thought was tumor

Florida surgeon removes healthy kidney he thought was tumor

The Palm Beach Post reported last week that Maureen Pacheco has sued Ramon Vazquez and two other surgeons for malpractice.
Published: 11/07/18
Hamburger Mary’s in Ybor City to close in wake of worker testing positive for hepatitis A

Hamburger Mary’s in Ybor City to close in wake of worker testing positive for hepatitis A

TAMPA — After nine years in Ybor City, Hamburger Mary’s Bar and Grill is closing, owner Kurt King said Tuesday evening.King and co-owner Brian DeChane had announced on Facebook that Tuesday would be the last night the Ybor City restaurant would be op...
Published: 11/06/18
Updated: 11/07/18
Toasted Monkey employee on St. Pete Beach tests positive for hepatitis A

Toasted Monkey employee on St. Pete Beach tests positive for hepatitis A

A food service worker at the Toasted Monkey Beach Bar on St. Pete Beach tested positive for hepatitis A, Pinellas County health officials announced Monday, marking the second such incident in the last two weeks in Tampa Bay.The two cases, along with ...
Published: 11/05/18