For some consumers, loyalty outweighs price

Sanford Health published a website in 2009 that included the estimated out-of-pocket cost of the 25 most common conditions it treated. The South Dakota-based provider hoped it would start a dialogue and help patients become more engaged and discerning shoppers.

But after a week of hype and relatively heavy use, people stopped visiting the site, said Cindy Morrison, Sanford's chief policy officer.

"It just didn't go anywhere," she said. "People didn't frequent the website."

Part of it could have been that people don't have the time to price shop in emergency situations. Or they expect insurers to cover the bulk of the costs. Or people opt to go to a familiar provider or physician they trust, Morrison said.

Patients who aren't aware of variations in procedure costs in different settings can drag down a health system's bottom line. Patients who go into the high-cost setting of an emergency department for routine care will bear more out-of-pocket costs. Hospitals will also suffer when they are unable to recoup those costs, Morrison said.

"We have an obligation to talk about those things and begin to try to educate on how to use healthcare services in a smart way, that will reduce some of the cost," she said. "When you have a more educated consumer, everyone benefits…but as a society, we are not there yet."

Sanford's experience isn't unusual. A new study published in the August edition of Health Affairs found that only 13% of Americans who had some out-of-pocket spending in their last healthcare visit had asked about their expected spending before receiving care. Just 3% of the 3,000 Americans polled had compared costs across providers before receiving care.

Consumers are having trouble finding quality price information and are reluctant to disrupt their existing provider relationships despite rising out-of-pocket costs, a wide variation in healthcare prices and increased availability of price data, the study found.

Seventy-two percent of respondents agreed or strongly agreed that having more patients compare the cost and quality of medical services when choosing doctors would be good for the United States. But 77% reported that they elected not to shop around because they wanted to stick with their provider and 75% said they did not have a source to compare prices. Only 19% of respondents indicated that time was the reason they did not consider other providers while 13% reported that they did not do so because their health plan limited their choice and 2% said they lacked alternative providers.

"The difference between Americans' willingness to price-shop for care and the rates at which they do so is striking," researchers wrote in the study.

A similar study found that half of its respondents tried to find out how much they would pay out of pocket before receiving care and 20% tried to compare prices. Another study revealed that only 11% of its respondents used price transparency tools.

This dynamic will likely change, Morrison said. As premiums go up and high-deductible health plans become more prevalent, there will be more discerning healthcare shoppers, she said.

"We are getting more calls and seeing more of that," Morrison said. "As these things emerge people begin to ask more questions, but it is slow."

Lawmakers have introduced new legislation calling for more transparent data on procedure costs and arming consumers with more tools to price shop, which they hope will bend the cost curve. In the meantime, shopping around for healthcare services seems to be a gradual undertaking.

"We need to mandate transparency," Dr. James Weinstein, the former president and CEO of Dartmouth-Hitchcock who retired in June, said at Northwestern's Healthcare Symposium in May. "You need to know what it costs to have your doctor do a total hip replacement before you go in the office and you need to know what his results have been for the last 100 of them. You need to have those benchmarked against other providers so you have an informed choice."

The study advocated increasing the availability of information on prices that's easier to understand. Patients often must know specific procedure codes to obtain prices, and differentiating between professional and facility fees makes the process even more difficult. Most Americans do not have basic information on how their plan is structured, which also complicates things.

The policy trends advocating for more price transparency to curb spending versus the push toward more coordinated care clash, researchers said. Models that focus on coordination under a single provider or health system discourage price shopping, and this conflict needs to be resolved to facilitate more price shopping, they said.