Humana publishes some procedure prices in Wisconsin online

The insurer wants to make consumers more aware of the cost of care.

By Jonathan G. Bethely — Posted March 27, 2006

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Milwaukee vascular surgeon John D. Riesch, MD, says he's happy to have another tool at his disposal to help patients manage their medical care -- a price list.

"You go buy a car, the price is listed," Dr. Riesch said. "Why shouldn't the cost of these procedures be listed?"

About 44,000 members of one of Humana's new health plans in Milwaukee will have access to the estimated costs for 31 inpatient and six outpatient operations and tests at area hospitals.

Humana's national accounts director, Tom James, MD, said the prices posted on the Web site are estimates of the total cost -- hospital plus physician costs -- for an entire episode of care. The listed price includes the consumer's and the insurer's shares, lumped into one number.

Humana said it consulted with hospitals and physicians to nail down the most accurate cost estimates for procedures listed on the Web site. For instance, Humana lists a colonoscopy ranging from $940 to $1,150 at one hospital up to $2,890 to $3,530 at another. The price of a C-section can range from $9,400 at one hospital to $14,250 at another.

Dr. James said Humana is testing the price list in the Milwaukee area, but this year other states will be able to view price lists for some of the most common medical procedures.

That Humana is publishing the prices of these procedures is largely due to a plan pushed by the Business Health Care Group of Southeast Wisconsin, a collection of the region's largest employers formed three years ago to find relief from rising health care costs.

A 2002 study of $470 million in Milwaukee-area claims showed costs were 55% higher than in other major Midwestern metro areas, according to research by the consulting firm William M. Mercer.

Humana's Web site is not giving any quality ratings to the facilities whose prices are posted, although the site includes the number of times a procedure is performed, mortality rate and average length of stay. Organized medicine in general has encouraged releasing price information and says it should be as transparent as possible.

James Ketterhagen, MD, president of the Medical Society of Milwaukee County, called the Humana effort "a step in the right direction."

Though the Humana price list does not break down procedures in detail, such as how much is represented by physician charges, hospital charges or other categories, physicians in Wisconsin said they were encouraged by the company's move, particularly in that it consulted with doctors before posting a list.

Patients in Wisconsin also can visit the Wisconsin Hospital Assn.'s Web site for information about how much hospitals statewide charge for various services.

As early as 2007, Wisconsin residents could see a public report measuring the efficiency of physician practices.

The newly formed Wisconsin Health Information Organization is working on the report, based on a statewide repository of health insurance claims data.

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