“In reality, there isn’t really a single, true price in our system in the US, for a given healthcare service,” says Graham. “?Almost all bills are paid with adjusted prices, adjusted in confidential contracts between a legion of payer sources and the hospitals. Those prices ultimately paid are not known prices to the average consumer, if you will. They’re distorted by some of the back-and-forth deal making for a hospital system’s ultimate goal to have an overall beneficial payer contract,” he says.
Hospitalists’ lack of price awareness could also transfer over to the patient, who oftentimes does not have the choice in what tests are ordered, adds Graham. Unlike in the outpatient setting where a patient can choose not to go to the pharmacy to pick up a prescription, inpatients in acute care settings are often too sick to make those price comparison decisions.
“It would be almost unheard of for you, the individual patient, to be able get a clear price on a menu before the service is delivered. Almost always, those prices would take place in deals between an insurance payer and a facility, and the individual patient or the doctor who ordered the test would be left out of knowledge of that information,” says Graham.
Patients and hospitalists are not trained in price awareness, according to Graham. After a case is completed, there’s little opportunity to revisit a patient’s case to see how much it cost the patient, he says.
The testing trend
In addition to confidential pricing structures and a lack of price awareness training, today’s physicians also tend to order more tests to be on the safe side, which poses a disturbing trend to run up costs. Graham, who teaches residents, says that inexperience can contribute newer doctors’ urge to check off more tests on the lab forms. In addition, medical legal pressures can encourage physicians to order more tests.