New tools to make notoriously opaque health care pricing more transparent show wide variation in costs among New Hampshire health care organizations.
Thanks to a federal hospital tariff transparency law which came into effect in 2021, Granite Staters now has the ability to compare prices for common procedures based on their insurance plans. The intention, among other things, was to help patients save money.
Most New Hampshire hospitals have a public list of common medical procedures, along with their corresponding cost negotiated with insurers, as required by the new law. Advocates hope transparent pricing will draw attention to areas where prices for medical procedures are inflated.
Prices for standard planned procedures can fluctuate widely across the state and even in similar geographic areas.
However, the new effort of transparency has its limits. Comparing the exact same procedure between different installations can be tricky.
For example, at Elliot Hospital, inserting catheters into the heart “to record, pace, and attempt to induce an abnormal heart rhythm” costs $9,445. However, Elliot does not take into account the differences between insurance plans, which can vary wildly. At Concord Hospital, inserting a catheter into the heart for diagnosis costs $15,041 for those with Blue Cross insurance and $3,842 for patients with Ambetter.
Health care prices may even differ within the same health care system, according to price data examined by the Monitor.
Emergency room costs for a condition of medium complexity, such as mild asthma or traumatic brain injury, vary by several hundred dollars at different Concord Hospital locations in Concord, Laconia, and Franklin.
Fees for a low-level ER visit in Concord are currently higher on average than in Franklin or Laconia. Similarly, when comparing median negotiated prices, the fees charged to insurance companies for a brain MRI in Concord are about double what they are in Laconia and Franklin for the same procedure. A vasectomy in Concord costs nearly double ($758) the median cost in Laconia and Franklin ($392).
Concord Hospital acquired LRGHeathcare from bankruptcy in 2021 and is working to make costs between facilities more consistent.
“Our goal is to ultimately offer consistent gross charges across all three hospitals when costs are the same. The process is not in place yet,” said Erin Cutter, director of revenue integrity at Concord Hospital “That said, there are many scenarios in which it would not be appropriate to offer consistent pricing due to a myriad of variables.”
Experts say many factors go into setting commercial reimbursement rates, including the length of the procedure, the cost of equipment, supplies and services, and the acuity and complexity of the patient receiving the service. In other words, an estimate and the actual cost can vary significantly.
Dr. Elliot Fisher, a Dartmouth researcher who studies healthcare spending, said higher costs are almost always passed on to patients.
“All of that is either reflected in the price they pay through their high-deductible health plan, because they have to pay the first $5 or $10,000,” he said. “Otherwise it’s built into their bonuses.”
Fisher said patients insured through their employers are often still to blame for rising health care costs. Several health economists found that when health care costs rise, employers often raise their workers’ premiums or cut benefits.
Fisher said seeking the best price on routine procedures can result in savings for individuals and lower prices. But this is not always practical, especially in emergency or emergency situations.
Some researchers have found these transparency initiatives to be successful — a study found that New Hampshire’s statewide Transparency Database resulted in a 3% decrease in the cost of medical imaging procedures, such as MRIs and X-rays, for patients over a period of five years.
Lucy Hodder, director of health law and policy at UNH Franklin Pierce School of Law, said price transparency and price comparison tools can help consumers find lower-cost alternatives, but much greater systemic pressures are needed to reduce costs and improve access.
“We have no system-wide accountability to really reward or drive value,” she said.
Rising healthcare prices have been increasingly onerous for Granite Staters.
A report 2021 from the New Hampshire Insurance Department showed that, on average, Granite Staters consistently paid higher health insurance premiums than the national average and the averages for most New England states.
The same report also found that the average franchise in the Granite State was significantly higher than the United States average.
These higher-than-average costs can be attributed to a number of factors: New Hampshire is a small state, which means that big industry expenses — like new cancer centers or expensive new wonder drugs — are spread on a relatively small group, making it more expensive for each individual.
The state has also undergone several hospital mergers in recent years, giving hospitals more bargaining power with insurance companies and was shown raise prices accordingly.
Hodder said high prices have impacted people’s ability to access health care. A national survey found that a third of Americans skipped care in the months leading up to October 2021 due to cost.
“Rising healthcare costs in New Hampshire are having a huge impact on families and businesses,” Hodder said. “I think our suppliers are struggling to figure out how to handle it.”