Massachusetts health plans post prices on the Web

Harvard Pilgrim Health Plan has joined two other insurers in Massachusetts that are using Internet Web sites to tell patients how much their treatment costs -- information that incorporates physician and hospital fees and expenses relating to lab tests and diagnostic procedures.

The sites are aimed in particular at those enrolled in high-deductible, consumer-directed group plans who might be motivated to keep out-of-pocket costs as low as possible.

On Wellesley, Mass.-based Harvard Pilgrim's site, items range from urinalyses ($3 to $5), liver-function panel blood tests ($11 to $17), and allergy shots ($20 to $24), to myocardial perfusion scans ($589 to $1,009), brain MRIs ($717 to $1,240) and arthroscopies ($2,141 to $3,180).

The costs listed take into account all care associated with a given medical service, including the discounted fee paid to the physician. A serum cholesterol test, for instance, would include the cost of drawing blood, the price of the lab work and the physician payment. The range of prices represent a spectrum of costs that varies because doctors' and hospitals' contracts have different fee schedules.

Although doctors sometimes have been able to get pricing information from payers, allowing patients themselves easy access to the cost of care is a new development with the introduction of consumer-directed plans. These plans offer relatively low health premiums, but deductibles typically are $1,000 or more for individuals or $2,000 for families.

Waltham, Mass.-based Tufts Health posted a similar list of prices on the Internet in January, and Boston-based BlueCross BlueShield of Massachusetts made public a brief listing of its prices in 2003.

New England traditionally has been a first-dollar, HMO insurance market in which few patients have a reason to know about the cost of their medical care, said David Cochran, MD, senior vice president for strategic development at Harvard Pilgrim. But 42,000, or about 5% of the plan's members, are now enrolled in high-deductible plans and have strong motivation to spend as little as possible, at least until their deductibles have been met. And these plans appear to be growing in popularity.

Although patients should trust their doctors' advice on appropriate treatment, Dr. Cochran said, sometimes alternative courses are possible, and patients can reasonably make choices to save themselves money.

Dr. Cochran gave the example of a patient with back pain who might save by avoiding an MRI scan -- costing $545 to $678, according to his company's Web site -- in favor of continuing with outpatient physical therapy in the hope of improvement.

The latter course, according to the Internet site, would cost about $40 for each 15-minute period of therapeutic exercise.

Mixed reaction

The Massachusetts Medical Society doesn't have an official position on the Web price listings, but one doctor said he had mixed feelings on the Web sites.

Patients being more aware of the cost of care, and being able to talk about cost with doctors, is generally "a good thing and desirable," said James F.X. Kenealy, MD, an otolaryngologist in Framingham, Mass.

"We tend to assume price is no object, and that really is unsustainable," he said.

But Dr. Kenealy said too great an emphasis on prices could spur patients to reject tests or procedures they need.

"I'm concerned patients may refuse appropriate therapy or diagnostic testing based on economic concerns," he said. "I get extremely nervous when patients are referred to as 'consumers,' because we're not talking about comparing milk prices between supermarkets. There is a fundamental dependence between doctor and patient that goes beyond economics."

Such worries should not be discounted, because there's "a definite risk" that some patients will forgo care they need because of what they read on Internet price lists, Dr. Cochran of Harvard Pilgrim said. But the rising cost of care and health insurance has made new approaches to moderating spending necessary, he said.

The Internet price lists should be viewed as just a tool to aid patients in talking about care with doctors, and to bring about decisions that are both clinically appropriate and cost-effective, said John Freedman, MD, medical director for clinical quality and informatics at Tufts.