Joint replacements are the #1 expenditure of Medicare. The process of approving these medical devices is flawed according to the Institute of Medicine. It is time for patients' voices to be heard as stakeholders and for public support for increased medical device industry accountability and heightened protections for patients. Post-market registry. Product warranty. Patient/consumer stakeholder equity. Rescind industry pre-emptions/entitlements. All clinical trials must report all data.
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Tuesday, February 12, 2013

Blind Shopping. Hip Replacement Costs.

By Melanie Evans   Modern Healthcare    FiDA highlight
Posted: February 11, 2013 - 12:01 am ET

Hip replacement surgery prices varied by more than $110,000 across the U.S.—at least, for hospitals and physician offices that provided prices when asked, a newly published survey shows.

Not all hospitals surveyed provided prices, and among those that did, not all could quote the price for hospital and physician fees, and some did so only after repeated phone calls, researchers wrote in Journal of the American Medical Association Internal Medicine online.

“Obtaining pricing information was difficult and frequently required multiple conversations with numerous staff members at each hospital as well as affiliated physician offices,” the study said. More than one-fourth of hospitals didn't quote a price until at least the third call. (Researchers called up to five times for a price.) Often, hospital employees were confused, uncertain and did not return messages, the authors wrote. “It is sobering to compare our experience with the best practices we have come to expect from other service industries.”

Meanwhile, prices “varied nearly 10-fold across hospitals” despite a standardized request. The total price, including hospital and physician fees, ranged from $12,500 to $105,000 among the top-ranked hospitals and $11,100 and $125,798 among randomly selected U.S. hospitals.

Researchers called two randomly selected hospitals in each state plus the U.S. News and World Report top 20 hospitals for orthopedic surgery. Hospitals were asked for the lowest price, including physician fees, for a hip replacement for a 62-year-old woman with no other conditions and no insurance.

Prices may have varied depending on whether hospitals quoted the sticker price or offered a discount or because of amenities or other differences, the authors said.

Nineteen hospitals, including nine top-ranked hospitals, quoted researchers a bundled price for hospital and physician services.

Another 19 hospitals failed to provide any prices, including three top-ranked hospitals. Some hospital patients must first see a doctor. Others said prices could not be provided over the phone. And some said “they had no way to provide such an estimate,” the authors wrote.

Another 57 hospitals and physician offices provided prices separately, which allowed researchers to come up with an estimated price.

Researchers obtained a partial price for the remaining hospitals.

Hospitals may have not responded to the push for price transparency by policymakers and health insurers, which have increased the financial incentives for households to shop around, the researchers wrote.

Last year, one-quarter of U.S. workers were covered by health plans with a deductible of at least $1,000, compared with 6% of workers six years ago, according to the Kaiser Family Foundation. Some health plans now cover surgery with a lump sum, known as a fixed-dollar contribution; patients must pay the difference between the insurance payment and the price of surgery.

“Our results suggest that such efforts at pricing transparency have not been well integrated into the operations at many hospitals,” the paper said.


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