Availability of consumer prices from US hospitals for a common surgical procedure

Abstract

Importance: Many proposals for health care reform incentivize patients to play a more active role in selecting health care providers on the basis of quality and price. While data on quality are increasingly available, availability of pricing data is uncertain.

Objective: To examine whether we could obtain pricing data for a common elective surgical procedure, total hip arthroplasty (THA).

Design: We randomly selected 2 hospitals from each state (plus Washington, DC) that perform THA, as well as the 20 top-ranked orthopedic hospitals according to US News and World Report rankings. We contacted each hospital by telephone between May 2011 and July 2012. Using a standardized script, we requested from each hospital the lowest complete "bundled price" (hospital plus physician fees) for an elective THA that was required by one of the author's 62-year-old grandmother. In our scenario, the grandmother did not have insurance but had the means to pay out of pocket. We explained that we were seeking the lowest complete price for the procedure. When we encountered hospitals that could provide the hospital fee only, we contacted a random hospital affiliated orthopedic surgery practice to obtain the physician fee. Each hospital was contacted up to 5 times in efforts to obtain pricing information.

Setting/participants: All top-ranked and a sample of non-top-ranked US hospitals performing THA.

Main outcome measures: Percentage of hospitals able to provide a complete price estimate for THA (physician and hospital fee) for top-ranked and non-top-ranked hospitals and range of prices quoted by each group.

Results: Nine top-ranked hospitals (45%) and 10 non-top-ranked hospitals (10%) were able to provide a complete bundled price (P < .001). We were able to obtain a complete price estimate from an additional 3 top-ranked hospitals (15%) and 54 non-top-ranked hospitals (53%) (P = .002) by contacting the hospital and physician separately. The range of complete prices was wide for both top-ranked ($12,500-$105,000) and non-top-ranked hospitals ($11,100-$125,798).

Conclusions and relevance: We found it difficult to obtain price information for THA and observed wide variation in the prices that were quoted. Many health care providers cannot provide reasonable price estimates. Patients seeking elective THA may find considerable price savings through comparison shopping.