Price transparency will improve patient care

Debora T. had a blood pressure of 180/110 during her routine visit in my internal medicine clinic. She was already on every blood pressure medication I could think of, save one — amlodipine. I prescribed the medicine and asked her to follow up in a week. I feared her blood pressure was going to cause a stroke if it went up any higher.

At our next visit, her blood pressure was unchanged. She had not bought the medication. Unfortunately, the pharmacy she happened to shop at was charging $100 for this generic prescription — and “my family just can’t afford that right now”.

Kmart charges $5 a month for amlodipine, if you buy it in a 90-day supply.

Joan K. found a lump on her chest wall. I sent her for an X-ray. The radiologist reported, “a shadow that might be lymphoma.” He recommended an MRI to better evaluate. Joan had insurance — but with a very high deductible. She called the MRI center I had referred her to (a major academic institution in Chicago) and discovered it would cost her over $3000, out of pocket, for this test. Joan spent many sleepless nights worrying about whether or not she had a potentially terminal illness — and whether or not she could afford to find out.

A local, free-standing American College of Radiology-accredited MRI center charges as little as $350 for a non-contrast MRI.

Carmen R. lost her job in real estate. She was in her early 60’s — still too young to get Medicare insurance coverage. Her prospects of getting another job, at her age, in a down-spiraling real estate market, were grim. She knew it was time for a mammogram but she decided that perhaps this year, she would skip it, since she was not sure when or if she would be getting another paycheck. The place she normally went for her exam charged about $400. She told her daughter about her decision not to get a mammogram.

A local hospital offers screening mammograms for $67.

All three of the above cases illustrate how the lack of pricing transparency in healthcare is dangerous and can cause serious morbidity. The first two cases are actual patients from my practice in Chicago. The last case, Carmen R, is my mother.

Inspired by all of them, I developed a free community service website called LesliesList.org that spotlights and compares medicine and diagnostic testing prices. These cases also illustrate that, as docs, we MUST ask our patients if they can afford the medicines and testing that we are prescribing. And we must help them find a way to afford them, or find an alternative, if at all possible.

The good news is, our LesliesList data show that many drugs and tests that seem unaffordable at first glance can often be found for dramatically cheaper prices. And with more price transparency in the healthcare market, as in any market, this should eventually lead to lower prices overall.

Maybe then more of our patients will actually fill their prescriptions and get the testing we recommend for them — because they’ll know they can afford it.

Leslie Ramirez is an internal medicine physician and founder of Leslie’s List, which provides information that enables all patients, but especially the uninsured and underinsured, to find more affordable medications and health care services.

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  • http://www.drrjv.com Bob Varipapa

    Great post. Hospitals and health care facilities should post prices (can you think of any other business that doesn’t?)

  • rezmed09

    So much for all the empty talk of “free market” “capitalism” and “efficiency of the private sector” – what a load of C__P.

    The only people negotiating for lower costs, the only people able to negotiate are big companies and the government. Only “little people” pay full price.

  • Leon

    I find posts like these contradictory to the belief that if patients were resonsible for the cost of their medical care, they would make better decisions.

    Our Lady of the Resurrection Medical Center provides the cheapest mammograms because it is backed by Catholic charities. Those providers that charge more are just trying to make a living and perhaps don’t have access to donations.

  • http://www.davisliumd.blogspot.com Davis Liu, MD

    I don’t think price transparency alone will lower costs. There is a lot of duplication, unnecessary testing which is difficult address and if eliminated would lower costs as well (in addition to having a more robust primary care workforce).


    Davis Liu, MD
    Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
    Website: http://www.davisliumd.com
    Blog: http://www.davisliumd.blogspot.com
    Twitter: davisliumd

  • family practitioner

    How in the world to you compare prices in the setting of an emergency?

    I had an MI recently and did not exactly have the time to “shop around” for the best deal regarding my stent.

    This transparency argument only goes so far.

    • http://www.leslieslist.org/ Leslie Ramirez, MD

      To family practitioner, et al.

      I didn’t mean to imply for a second that pricing transparency is the cure to our healthcare woes. But isn’t it remarkable how little transparency there is? What might happen if healthcare pricing was as transparent as say, airline tickets or books? Could it shift the healthcare industry’s ecomomics in the consumer’s favor- as happened with Orbitz and Amazon?

  • JustADoc

    While many doctors would love to advertise our prices and compete based on price and quality and satisfaction, we are federally mandated to not do so. That’s right. It’s actually illegal for doctors to post their prices if they accept Medicare. Stupid beyond belief? Absolutely. But still true.

    JustADoc

  • ninguem

    This gets so tiresome.

    No, you don’t price shop for MI treatment. Your insurance does, it’s called a “network”.

    One pharmacy charges $100 for amlodipine, a K-Mart pharmacy nearby charges $15, you don’t think the patient will make the right choice?

    Problem all along has been that the patients don’t have this information. They didn’t KNOW there was a better price available. Thanks to organizations like LesliesList, now they will be able to find that info, at least in her area.

    Yes, the patients DO shop price, they DO make the right decisions, and it is reflected in premium for the HDHP’s attached to HSA’s.

    HSA’s have existed for five years now, they do have the data supporting that. Naturally, the Obama administration and this current Congress is doing everything they can to kill them off.

  • http://www.consentcare.com Martin Young

    Information about cost of services is supposed to be part of fully informed consent.

    Where I practice, this is a person’s constitutional right, and one could argue that failure to discuss cost is a violation of those rights.

    In a litiginous society that is a dangerous position for a doctor to be in, even if the treatment was successful!

  • jsmith

    Of course this whole issue of price transparency would go away if we had a rational HC system, single-payer with guaranteed basic HC for all. But who am I kidding? I forget what country we’re in for a minute.

  • http://noscales.com Ron Hekier, MD

    On a related note, also needed is price transparency for physicians to see what insurance providers reimburse all MDs in the same specialty nationwide.
    When I find out that insurance company X pays me 30% less for a procedure than a surgeon in another city I can choose whether or not to stay in network for that insurance provider.

  • http://www.brightonyourhealth.com Mary Brighton, MS, RD

    Dear Dr. Ramirez,
    Thank you for your post which brought up valid points. What I personally see is that sometimes people will not buy medicine prescribed nor undergo necessary testing due to costs of these items. What we forget is that 1. some people do not realize that costs can be different depending on which pharmacy or testing center. 2. some people truely cannot afford these medicines or tests.
    I think your website is valuable: setting up a list of places of lost cost services.
    As health care professionals we need to be open enough to realize that people don’t always have the money or education to complete “what the doctor ordered.”
    And, in the end…we will all pay for it, of course, the patient, their families, insurance companies, government etc..
    Because when patients don’t take their blood pressure medicines, or don’t get that mammogram..stroke , cancer.
    I should know, my dad didn’t take his blood pressure medicine. He did have the stroke. He is in the wheelchair for life..and looking at his bills the health insurance company covered? Way over a million dollars..But the cost of the pain to my family to see my dad suffer…that is without words.
    Keep up your efforts!
    Mary Brighton, MS, RD