Shopping for health care made easier with new state website

A new tool for California health-care shoppers shows how widely prices can range for medical procedures county by county, and that for many procedures, health costs in the central San Joaquin Valley are some of the lowest in the state.

Take the cost for a total knee replacement.

It costs less on average to have knee surgery in the Valley than anywhere in the state, according to California Healthcare Compare, a new website. In Fresno, Kings and Madera counties, the average cost is $21,612. The highest cost for a total knee replacement in California is in Alameda County, where the average cost is $55,542.

The website, launched in September by the California Department of Insurance, includes the average cost for what a patient might expect to pay for a procedure and the average cost paid by insurance.

Cost information is provided on 100 procedures, ranging from treating a broken ankle to chemotherapy, and it gives quality ratings for five common conditions or procedures, including childbirth, hip and knee replacement, diabetes and back pain.

Health-care providers say California Healthcare Compare can be useful for patients, but they caution that costs and quality are complicated calculations. Others say it holds information that consumers can use to find affordable and quality care.

“The website is a very important step toward greater price transparency, but there’s still more to do,” said Anthony Wright of Health Access California, a statewide health-care consumer advocacy coalition.

There are limits to the website, he said. It doesn’t account for complications and other conditions that don’t neatly fit into categories. And people aren’t in a situation to do comparison health-care shopping during an ambulance ride for an emergency, Wright said.

Patients mostly rely on insurance companies to negotiate the best prices for health services, he said. “Really, it’s your insurer who should be having this information and directing you to the best price.”

California Healthcare Compare, created by the University of California at San Francisco, researchers and Consumer Reports for the state Department of Insurance, encourages patients to visit their own insurance website for a personalized estimate of their share of the cost of procedures. And it prompts health consumers to share their medical stories and bills to add to the cost information available on the website.

Increasingly, consumers have health plans with high deductibles that must be met before insurance coverage kicks in, which gives them motivation to check costs before seeing a doctor or undergoing an elective medical test or procedure.

In the case of a knee replacement, for example, consumers in Fresno, Kings and Madera counties and in North Bay counties pay nothing – zero – on average for knee replacement surgery, according to California Healthcare Compare. On the other hand, consumers in Merced and Tulare can expect to pay $30 on average. The highest out-of-pocket cost for a knee replacement is $750 in western Los Angeles County.

The site calculates average out-of-pocket costs, and searchers on the website are advised to check with their health plans for a better estimate of what they will have to pay.

Some health plans, but not all, have online cost-estimating software that allows members to compare prices of health services.

HealthNet and Anthem Blue Cross, for example, have online sites.

Consumers should take the state website as a cost guide, but “you should also call your health plan for assistance in estimating the costs based on your specific policy, the kind of coverage you have and the kind of policy that you have,” said Brad Kieffer, a spokesman for HealthNet.

This year, tens of thousands of Anthem members have logged on to the health plan’s website to get cost estimates, said spokesman Darrel Ng. “This is a tool that is being widely used by our members so they can make informed decisions about their health-care costs and the facilities where they want their health care delivered.”

Cost variations affect ‘the norm’

Consumers may be surprised by regional cost variations they find on the new website, but price fluctuations dependent on where people live are not new in health care.

Health-care cost differences reflect everything, including employee salaries that vary by the cost of living, said Gary K. Herbst, senior vice president and chief financial officer at Kaweah Delta Health Care District in Visalia. Large metropolitan areas tend to have a higher a cost of living, which pushes up salaries, he said.

Herbst applauded California Healthcare Compare for using what hospitals get paid for services rather than billed charges, which are never paid fully by insurers, he said. But Herbst said comparing what insurance companies pay hospitals for services is complicated. The website appears to make it easy, but it’s not, he said.

“There’s not a single, uniform price system for all hospitals,” Herbst said.

And there is good reason for that, he said. Hospitals can provide different levels of services “and that all goes into the pricing.”

One hospital may negotiate with insurers for a higher reimbursement for a service that involves sicker patients in exchange for accepting a lower payment for another service. The total payment to the hospital could be very similar to that of another, but consumers would not know it by looking at an individual procedure and comparing what insurers paid, he said.

Understanding health-care costs is an evolving science, said Kieffer of HealthNet, and California Healthcare Compare is a good start in cost transparency, he said. “The more information we’re able to provide to the consumer, the better. The educated consumer tends to be a cost-conscious consumer.”

Cost is not the only variable that consumers need to consider when choosing a health-care provider, and California Healthcare Compare includes quality information for a handful of common procedures.

Websites to help consumers evaluate the quality of hospitals and other health providers have been around for years. For example, 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 such as asthma, heart attack, 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.

The Office of Statewide Health Planning and Development also tracks hospital outcomes and other health measures that the public can access.

And there are organizations, such as Leapfrog Group, Healthgrades and Consumer Reports, that provide hospital quality ratings.

Push-back by providers

Patients can find health comparison sites complicated to use and the information conflicting.

The California Department of Insurance has tried to make its site easy to navigate while gathering data from several sources, but providers say the quality data are old.

Kaweah Delta publishes quality information on its website that is current, Herbst said. But the state released data that is 2 years old, he said. “It’s frustrating that it’s old data.”

On one measure, for example, the state shows Kaweah Delta with a higher-than-state-average rate for stroke deaths, but the state number is for 2012-13, said Dr. Edward A. Hirsch, chief medical and quality officer. The hospital has improved, and its ranking this year is well below the state average, he said.

The quality information on California Healthcare Compare, however, is not worthless, Herbst said. “If it’s old but it’s accurate, that does give the patient, the consumer, some perspective,” he said. “But it doesn’t necessarily mean how we’re performing today.”

Patients should look at other sources, he said. “Call the hospital … ask ‘How are you performing today?’ ” Ideally, patients should talk to their doctors and to the hospital, he said. “Do your homework.”

The health-care consumer “should be much more selective, and they should be much more demanding,” Herbst said.

Wright of Health Access said people should not just look at cost but also at quality. “In health care, it’s just striking how little cost is correlated with quality.”

California Heathcare Compare is a big advance for consumers who are looking for affordable and quality health care, he said. “There’s just not very much consumer information in regard to quality.”

This story was originally published October 3, 2015 at 8:00 AM with the headline "Shopping for health care made easier with new state website."