New tool searches health prices by doctor, insurance

Starting Tuesday, consumers worried about high out-of-pocket health costs can search for procedure prices ranging from knee surgeries to vasectomies, based on their doctor and type of insurance so they can eliminate most of the surprise bills that show up long after their wounds have healed. 

Amino, a health data company that launched last fall, was already helping connect patients to doctors in their areas based on quality data. The new tool greatly expands its pricing data and covers about 550,000 physicians, 49 procedures and 129 insurance companies.  

While Amino is one of many public and private entities trying to help consumers shop for health care, its new tool gets as close as any have come yet to having such a wide range of details.

The information is based on hundreds of millions medical insurance claims, totaling $860 billion within the last year, to help patients plan for the seemingly never-ending series of bills that follow patients after any major procedure. 

"Gaining access to pricing information has proven incredibly difficult," says Amino CEO and co-founder David Vivero. "Industry efforts at price transparency have missed the mark."

Physician Neel Shah, who founded the non-profit Costs of Care, called Amino's effort "an important first step."

"Most of the way costs are communicated are not really using the language patients use," says Shah. 

Amino gives users several opportunities to click for more information about insurance and other terminology used. Whether a patient is uninsured or uninsured, Vivero says the goal is to give them "a leg up" when they visit their doctor's office. 

Vivero agrees with Shah, who says "it's always hard to know what all the costs are going to be" because a doctor may not know what a patient's full needs are until they've been evaluated. And even then, new issues may arise while a patient is under anesthesia. That's why Vivero says it's an estimate based on all the other people with the same insurance who went to the same doctor for the same procedure. 

"It's not a (price) guarantee but is using statistics to find the typical price," says Vivero. 

Shah says physicians can help too by doing a "better job explaining the range of possibilities" of what a procedure could involve — and cost. 

Health care costs are a challenge even for the experts to figure out. Elizabeth Munnich, an assistant professor of economics at the University of Louisville who specializes in health economics, says costs vary — even within the same hospital — because they are largely based on insurer negotiations with health care providers. So the overall mix of insurers, and the relative power of those insurers and the hospital system, influence prices.

One thing everyone should keep in mind, she says: A higher cost doesn’t necessarily mean better care, studies show. 

Munnich got some first-hand experience when she had a baby last year. She and her husband have a high-deductible insurance plan, so they asked about prices and discovered “nobody can actually give you a price.”

Even Amino can't — yet. But the company is working on that, along with prices for MRIs, which aren't done by doctors. That requires gathering of all new data from MRI centers.  

Charles Kodner, who practices family medicine with University of Louisville Physicians and teaches at the UofL School of Medicine, agrees that insurance reimbursements are a huge factor in what doctors and hospitals charge.A procedure's cost, he says, includes many factors, which makes it difficult to compare prices from place to place. For example, Kodner says, the total price for a stress test includes the cost of the procedure itself and those for nursing, supplies and the physician interpreting the results. Any of those costs could be different from one facility to another. 

Amino's estimates vary widely as well. In the Louisville area, for example, the median network rate for doctors in Louisville for ACL knee surgery is $4,272, which is low for the region, and the median network rate for doctors in Frankfort is $8,775, which is high for the region.

While shopping around for care based only on cost can carry risks (Amino does include quality data), Kodner recommends that patients press their physicians on whether it's necessary to "do the tests right now." He cited an initiative called Choosing Wisely, launched by the ABIM (American Board of Internal Medicine) Foundation to advance a national dialogue on avoiding unnecessary medical tests and procedures.

Even with all the tools available, Munnich says she doesn't think health care costs will ever be "fully transparent.”

But it can and should get closer, most experts agree. 

“The American healthcare system delivers miracles, but it also produces care of variable quality and backbreaking costs,” said physician Robert Wachter, who is interim chair of the department of medicine at the University of California, San Francisco, and a scientific adviser to Amino. “Part of the solution, undoubtedly, will be transparency: giving patients the information they need to make informed choices about the best doctor for their condition, and the best value."