Three years after passage of a state law requiring price transparency, physicians across the state are still failing to give patients reliable estimates for health care procedures, according to a report scheduled to be released Wednesday.
The legislation, which took effect in 2014, was meant to make it easier for patients to get reliable information about the cost of services, helping them shop for their care.
But a report from the Pioneer Institute, a public policy think tank, found that specialists throughout the state often took several days longer than the state allows to gather that information.
Half of the offices contacted — dentists, dermatologists, gastroenterologists, and ophthalmologists — were unaware of the law, according to Barbara Anthony, who wrote the report.
“What our law does is try to change attitudes and culture to make people more cognizant of value in health care,” Anthony said. “Doctors don’t even know what something costs when they send you for tests; they don’t have the foggiest idea.”
In conducting the study, the institute called specialists’ offices, inquiring about the prices of routine procedures. To eliminate the complication of health insurance, researchers only asked for out-of pocket prices. In most cases, only broad estimates were provided.
Estimates by dentists were the most specific, because many of their patients pay out of pocket, the report speculated.
The researchers contacted 23 dermatologists, requesting the price for both a routine exam and the removal of a wart. One office in Holyoke, they reported, estimated the cost of an exam to be somewhere between $85 and $400, depending on whether the doctor found something wrong. At a Kenmore Square office, wart removal ranged from $760 to $1,250.
Anthony said that there should be a clear breakdown of prices, rather than the current system in which a patient goes in “blindfolded” and is surprised by the bill.
Anthony said the study shows that staff were often not trained on how to process price requests, if they were even aware the law existed.
Though the law took effect only recently, advocates said the transition is taking longer than it should.
“It’s a new thing in health care, and maybe it’s going to take a while,” said Brian Rosman, research director of the advocacy group Health Care For All. “But it was passed in 2012, and we think it’s certainly within the ability of most doctors’ offices to get people to figure it out. I would expect doctors and hospitals would be further along than they are for now.”
But it’s not so easy for doctors to comply, according to the head of the Massachusetts Medical Society, a professional association for physicians.
For services with fragmented costs — such as colonoscopies, which combine the services of a surgeon, a clinic, and an anesthesiologist — the puzzle is a bit more complicated, and it is extremely difficult for a single provider to be able to give an accurate representation of all costs, said Dr. Dennis Dimitri, the society’s president.
Each clinic may work with several different anesthesiologists, and contracts between outpatient facilities and hospitals constantly fluctuate, he said.
“If I were a gastroenterologist, I may be able to tell you what I charge for a colonoscopy, but it’s another magnitude of order for me to accurately keep track of the costs beyond my control,” said Dimitri. “It would be wonderful if there were more coordination. . . . It’s certainly a worthwhile goal, but it is very difficult to accomplish.”
Anthony said that the general failure to comply with the new regulations may suggest that perhaps the law needs tweaking, or that providers need more guidance from professional organizations.
Rosman, of Health Care for All, agrees the law is complex, but suggests that state agencies need to work with health care providers to make sure the law is effective, and open a dialogue with doctors and consumers to figure out how to make it work.
The law does not specify a penalty for failing to meet the transparency requirements.
“For too long, patients have been told to go get your care, and you’ll find out in one, two, six months from now how much it costs,” Rosman said. “That’s not how we want this to work; people shouldn’t have this uncertainty hanging over their heads.”