The Price is Right

Shilpa Iyer in the Health Care Blog has a post on an interesting idea to try and teach Resident Physicians the cost of the care their patients are receiving. (the post was originally in a blog called Cost of Care).

With further discussion we realized that none of us knew the hospital charge, or the cost to our patients for routine workups we routinely order in our gynecology clinic. We really had no idea.

After asking around, I realized that I was not alone in my lack of knowledge, or the idea to play The Price is Right with hospital charges. A couple of years prior the Massachusetts General Hospital Internal Medicine residents had played a similar game with the goal to create awareness of the costs associated with routine workups.

The moved to create game that would meaningfully teach Residents about the cost of services. The most interesting part of the post for me is how hard it was to find out how much things cost (even leaving aside the difference between charge, payment, cost).

I started with our gynecology clinic practice manager (after she overheard me discussing where to find these numbers). She had some information on the visits to our gynecology clinic and hospital charges for the technical end for procedures. But, I soon realized that no one really knows how the hospital charge value is arrived upon, or if and how it changes year to year. And while she could tell me the charge for a RN intramuscular injection fee, she told me to contact the pharmacy for the drug charge. After asking around, I resorted to calling the individual labs/departments to find the appropriate costs. People were often willing to tell me as few people even ask. I called the pharmacy, hematology lab, microbiology lab, emergency room billing, hospital billing, the nurse practice manager for the family planning clinic who coordinates with the nurse in charge on labor and delivery, and a separate operating room billing manager. Because OR costs are determined in increments of 15 min, they are provider and case specific.

Interesting story. It would be useful if the cost of care was more transparent to all involved. Determining how to use information about cost and effectiveness is trickier; Aaron was writing about this yesterday with respect to new guidance from the American College of Physicians. Paul Kelleher weighed in as well.

You can see from comments to Aaron’s post, that there are many strong feelings about the role of doctors in using cost information to guide treatment.


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