Price Transparency in Healthcare: Why All the Secrecy?

December 5, 2011

Detailing physician fees in an online listserv got my post banned. Why all the secrecy about salary, fees, etc. when all we talk about is cutting healthcare costs?

Somewhere in the Internet milieu, I am a member of a pediatric hospitalist listserv that, at this point, probably has several-hundred followers. We discuss incredibly fascinating topics, such as urinary tract infections and bronchiolitis. We discuss patient cases - after getting family approval, of course, for fear of HIPAA regulations. And, we often wax on about our self-importance to the sustainability of the healthcare system.

One thing that we absolutely, positively do not discuss, however, is the cost of healthcare. Sure, there is the broad conversation - we decrease length of stay! But try to comment on a salary, or offer insights into the details of physician fees, and the moderator quickly comes back with a sharp rebuke and the posting is erased.

‘Sherman [Antitrust Act]!’ he’ll cry. Criminal, he’ll imply.

Thus comes the appropriate follow-up consideration:
Are physicians legally permitted to openly discuss the cost of healthcare? Or is this automatically some form of collusion, and thus a violation of anti-trust legislation?

For example, would the editor of this Physicians Practice blog be aghast and pull out a red pen (figuratively speaking, in this digital age) if I wrote the sentence: “For the CPT code 99223, which represents an initial inpatient assessment, my group charges $10,000”? Would he tell me that this is illegal?

(Author’s Note: Do I have to write that the number above - $10,000 - is obscenely fictional, for illustrative purposes only, and is not meant to represent a true charge? Does that save me from prosecution?)

What if I told you how much money I make?

In the real world, with real patients, this translates into the difficulty with transparency in pricing and allowing consumers (a.k.a. patients) to make educated, cost-effective healthcare decisions in non-urgent situations. While I routinely get a pamphlet informing me that an assessment of my dog’s stool is $35, or that a full, well-dog annual exam runs about $100, I have never received similar information from a physician’s office.

So I’m not simply casting stones: I’ve never provided this information to patients either. No one has asked, prospectively. And, even though I run my division, I’d have to go up the food chain to determine if this is something I’m permitted to do; or if it’s a good business decision for my prices to become part of the public domain.

The issue of price transparency in health care is prominent nationwide. The Deloitte Center for Healthcare Solution produced detailed guidance on the issue in 2007. It is a strange conversation to have about decreasing national healthcare costs when most people - including the people involved in the board-room discussions - probably couldn’t detail their own healthcare costs.

Sherman! comes up each time the question is broached. A 2011 guide produced by the Texas Medical Association details some of the basics of anti-trust law, and this is the core of any argument whether or not prices can be discussed among physicians. The general gist is an effort to prevent collective bargaining from non-related entities, and thus create a non-competitive workplace.

How my posting a physician fee on a national listserv violates this legislation is unclear to me. Foremost, most people aren’t in my area and thus we don’t negotiate with the same entities. Additionally, even if the guy next door here in Norfolk, Va., saw my pricing, I’m fairly convinced it wouldn’t be sufficient information - without evidence that he and I specifically engaged in deception - that we price fixed.

Anyone else face these issues?

By the way, for the subsequent hospital stay visit 99232, we charge…

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