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In California, the average out-of-pocket costs for an uncomplicated birth could cost a lot less in San Mateo County ($920) than in Alameda County ($1,300), Santa Clara County ($1,500) or Orange County ($1,800).
Thinking about a knee replacement? There’s a surprisingly wide variation in quality ratings among Bay Area hospitals for the procedure.
These are among the insights from a new consumer website unveiled recently by the California Department of Insurance to help Californians better shop for health care based on both quality and price. The site,
California Healthcare Compare, was created by UC-San Francisco researchers and Consumer Reports for the state insurance agency with a federal grant from the Centers for Medicare & Medicaid Services.
The site provides information on quality for five common conditions or procedures: childbirth, hip and knee replacement, colon cancer screening, diabetes, and back pain. And it gives cost information—by county for 100 procedures, ranging from treating a broken ankle to cancer chemotherapy.
“When it comes to health care cost and quality, it’s really a black box for consumers. They don’t know how much they’re going to pay,” said Doris Peter, director of the
Consumer Reports Health Ratings Center. “This website is a first step toward providing this information,” and it could serve as a model for other states to follow.
Websites to help consumers evaluate the quality of hospitals and other health providers have been around for years. But they often focus on cost or quality, not both, and remain a work in progress—even as consumers with high-deductible health plans under the Affordable Care Act are looking for better information to make smart health care decisions.
Nationally, the Centers for Medicare & Medicaid Services’
HospitalCompare website offers data on quality for 4,000 hospitals, allowing patients to review how well hospitals treat conditions like asthma, heart attacks, stroke or pneumonia, among other measures.
Californians also can find health care quality—but not cost—data at
CalQualityCare.org, which provides information on the state’s hospitals, doctor groups, nursing homes, assisted living facilities, home health and hospice services, adult day care, and services for the developmentally disabled. The site is run by the Oakland-based California HealthCare Foundation.
Patients can find the sites complicated to use, and providers
have pushed back against some quality rating methodologies. Rather than scrutinizing a website, consumers often will rely on personal recommendations from their physicians or friends and family to decide on where to have a procedure done.
Data on health care costs, much of it closely held by health insurers, can be even harder to gather and share with the public, although many ventures are trying, including
Healthcare Bluebook and
PriceCheck, a crowdsourcing collaboration between public radio stations and
ClearHealthCosts.com, a healthcare cost transparency startup.
The creators of the California Department of Insurance’s new site, California Healthcare Compare, are trying to push past those hurdles.
They’ve gathered health quality and cost data from state and federal agencies, including HospitalCompare, the
Integrated Healthcare Association,
California Maternal Quality Care Collaborative and insurance claims data.
Cost data is available for all counties except Kern, which only had one insurer at the time the cost data was last collected, in 2013.
In a written statement, California Insurance Commissioner Dave Jones said: “This is …a first step toward convincing doctors, hospitals and insurers and legislators of the benefits of sharing more detailed price information to allow consumers faced with high deductible plans to make better decisions.”
While California Healthcare Compare aims to be more comprehensive than other data sources, its usefulness for consumers remains to be seen. While the site breaks down average out-of-pocket costs for consumers and average costs that insurers pay, it can be difficult for consumers to figure out what their own costs will be.
The site helpfully links consumers to online out-of-pocket cost calculators maintained by major insurers including Kaiser Permanente, Aetna and Anthem Blue Cross, but some insurers still lack them. In addition, the site averages the low out-of-pocket costs of Medi-Cal patients with those of privately insured patients, which can be far higher. And consumers may find the disconnect between the total cost of a procedure—what insurers and consumers jointly pay to a provider—and their own out-of-pocket costs to be confusing.
Take total knee replacements. In Alameda County, where the surgery’s total average cost for consumers and employers is listed as more than $55,000—the highest in the state—the site estimates average out-of-pocket costs at only $86. In comparison, the total cost for the same surgery in Santa Clara County is just under $40,000—but the average out-of-pocket cost is about $300.
The site will evolve over time if funding can be sustained, said Dr. R. Adams Dudley, director of the UCSF Center for Healthcare value, which led the project. He hopes to add quality and cost data for many more conditions, and also provide cost data for individual hospitals and doctors’ groups.
What’s important is to continue the push to make health care cost and quality information more transparent, he said.
Public reporting of some quality measures, such as the rate of hospital-acquired infections, has forced providers to improve. Consumers wondering why their insurers pay so much for procedures in one county compared to another might talk to their company’s human resources department, which in turn can question insurers about those costs.
“These are the kind of conversations we want people to be having and the kind of shopping we want them to be doing,” Dudley said.
Barbara Feder Ostrov is a health journalist and editor based in the San Francisco Bay Area for
Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. © 2015 Kaiser Health News. All rights reserved. Republished with permission.
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