On platform, patients can compare costs, purchase vouchers for services
By JULIE MINDA
Despite a push by patients, patient advocates and government agencies for greater transparency and affordability when it comes to the prices of health care services, consumers continue to find pricing very difficult to understand; and they say costs are too high, according to polling.
More than 200 U.S. hospitals are trying to make inroads in addressing the long-standing complaints through the MDsave online health care marketplace. MDsave, a private, for-profit company based in Brentwood, Tenn., works with its health care provider clients to arrive at a single, bundled price for each of a range of medical tests and procedures. The company then posts those prices online and enables patients to purchase vouchers to receive the services at a given facility at those prices.
Facilities within St. Louis-based Ascension; Chicago-based CommonSpirit Health; Springfield, Ill.-based Hospital Sisters Health System; and Chesterfield, Mo.-based Mercy are among those that have signed on with MDsave. MDsave is one of multiple companies using online platforms as a conduit for health providers willing to bundle and discount episode-of-care prices so patients know ahead of time how much they will pay for a specific procedure or treatment.
Omaha, Neb.-based CHI Health, part of CommonSpirit, went live on the MDsave website in November. Dr. Cliff Robertson, CHI Health chief executive, says the service is designed for — and is proving popular with — people who are uninsured as well as people who have high-deductible health plans.
Robertson says offering the MDsave bundled pricing option to patients is in line with CHI Health's commitment to be more transparent, accountable and affordable when it comes to pricing.
Convoluted, expensive
The Centers for Medicare and Medicaid Services says hospitals providing services to Medicare-insured patients must post their standard charge master publicly. Additionally, dozens of states have passed laws requiring or encouraging hospitals, other health care facilities and/or insurance companies to be more transparent and clear with consumers about pricing and insurance plan coverage.
Clay O'Dell, CHA director of advocacy, notes price transparency is getting attention in Congress and could be addressed through legislation soon.
According to recent reporting from Kaiser Health News, several federal lawmakers are advancing legislation aimed at curbing "surprise billing," in which a patient gets unexpected bills, often for emergency care provided by out-of-network clinicians, but also for aspects of surgical care and other planned procedures. President Donald Trump has indicated he'd support action to curtail the problem.
There is widespread agreement in the industry that pricing and transparency are significant issues — though there is no such agreement on causes or solutions. "In today's marketplace, health care can be confusing and expensive, especially for consumers who are uninsured," John Jeffries says in a January release on a group of Hospital Sisters Health System hospitals launching an MDsave site. Jeffries is director of finance for one of those hospitals, HSHS St. Joseph's Hospital of Breese, Ill.
The American Hospital Association says it is challenging to offer straightforward, meaningful pricing information because health care services can vary so much by patient, and the out-of-pocket costs for services vary significantly based on individuals' insurance status and coverage. Health care systems, physician groups and facilities negotiate different rates with different insurers, and insurers for their part offer numerous plans to consumers, with varying levels of coverage and out-of-pocket cost.
Another complicating factor is that so many stakeholders are involved in the pricing and payment equation, including hospitals, physicians and other clinicians, pharmaceutical and medical device providers, commercial and government payers, employers, patients and regulatory agencies. All of this makes it difficult, if not impossible, for patients to figure out their out-of-pocket costs in advance of receiving health care services.
In 2017, Public Agenda, the Robert Wood Johnson Foundation and the New York State Health Foundation released a survey in which 63 percent of respondents said there is not enough information available about how much medical services cost. And a 2018 survey from the Commonwealth Fund found that people's confidence in their ability to afford health care had declined every year since the start of Commonwealth Fund's tracking of the measure in 2014.
New approach
MDsave's online marketplace publishes bundled prices for over 1,300 procedures at participating hospitals in nearly 30 states.
MDsave says it provides its health care clients a recommended rate for each service that is "based on a fair market analysis." The hospital has the final say on the services it will offer and the voucher price it will accept for a given service or treatment. Hospitals pay MDsave a monthly subscription fee and what MDsave describes as a "small fee" for each transaction when patients purchase the health care services.
The MDsave website provides examples of potential patient savings using the vouchers, with a complete blood count, for example, costing $20 as compared to an estimated national average of $40; a mammogram screening costing $202 as compared with an estimated national average of $400; and a colonoscopy costing $2,127 as compared with an estimated national average of $4,412.
Most patients need a valid physician order to use MDsave. According to MDsave's website, patients then can geographically search for what they need by procedure, provider, specialty or ailment; make an apples-to-apples comparison of bundled prices guaranteed by competing providers; purchase vouchers for the services they choose to use; and then bring those vouchers to the participating provider to cover the full cost of the services.
The participating hospitals put together the team of providers that will deliver the full scope of services needed to fulfill the voucher, according to information from CHI Health and HSHS.
MDsave says patients can use pretax dollars in health savings or flex spending plans to purchase their health care services through the online marketplace. MDsave also markets a credit card that enables patients to finance their purchases.
Scaling up
CHI Health and HSHS say they are starting with a menu of basic health care services and will expand the list over time. For instance, the HSHS Southern Illinois Division hospitals currently using the platform offer it for diagnostic imaging such as ultrasounds, CT scans and MRIs. They plan to expand the list later this year to include laboratory testing, physical therapy and some medical procedures.
CHI Health says it offers some services through the MDsave platform that are not covered by insurance, such as plastic surgery or new treatments still under review by insurers for coverage approval.
The hospitals will build out the list further in the future.
Formerly a family doctor, Robertson says clinicians at CHI Health value "being able to help on the spot when that dreaded exam room question comes up: 'How much will this cost?'
"Now we have a tool that is very easy to use and consumer friendly," to answer the question, and to provide more manageable costs.