[Congressional Record (Bound Edition), Volume 145 (1999), Part 15]
[Extensions of Remarks]
[Page 21758]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 21758]]

             SHOPPING FOR HEALTH CARE SHOULDN'T BE SO HARD

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                     Wednesday, September 15, 1999

  Mr. STARK. Mr. Speaker, we all know the problems that the high cost 
of health care causes for Americans. What is surprising is how hard it 
is for a patient/consumer to shop around for the price of a medical 
procedure.
  Shopping for the best price on a standard medical procedure is 
extremely difficult when one is healthy. It becomes nearly impossible 
when one is sick. Medicare should lead the way in helping establish 
pricing information that could help consumer/patients make their health 
care dollar stretch.
  Over the last few weeks, my staff has made calls to various hospitals 
and doctors' offices to find the cost of an Extracorporal Shock Wave 
Lithotripsy (ESWL) procedure. A lithotripsy procedure is one of the 
best ways to treat kidney stones, one of the more painful types of 
medical conditions that forces at least 100,000 Americans to require 
medical attention a year. Lithotripsy, an outpatient procedure which 
takes about an hour, uses a high energy machine to deliver shock waves 
to the kidney stone, smashing it to smaller pieces which then gradually 
pass out of the kidney, and then the body.
  The data from these calls about the cost of lithotripsy were eye 
opening. Not only was the price difference between hospitals and 
facilities notable, but so was the difficulty in gathering the 
information, especially the cost of this procedure for Medicare 
enrollees.
  For example, in the Greater Washington area, total cost of 
lithotripsy varied from approximately $5,400 at Johns Hopkins USA 
hospital to approximately $9,000 at George Washington University 
Hospital. The following chart lists other hospitals' and doctors' 
responses to the questions of cost for (1) someone without insurance 
and (2) someone with Medicare. What was as upsetting as the price 
differences was the difficulty in finding the cost to Medicare 
enrollees of this standard procedure. Staff was often told that 
hospital-using patients would be charged the 20% approved Medicare 
rate. In fact, patients often pay up to 50% of the Medicare Hospital 
Outpatient Department (HOPD) approved rate, which is a huge burden to 
the patient.
  Along with the underquoting of a patients' future bill, staff at many 
hospitals were not able to supply information about what was the 
approved rate that Medicare would pay, which would make it impossible 
for patients to plan ahead for their future bill.
   Mr. Speaker, Medicare is moving to a Prospective Payment System for 
Hospital Outpatient Department procedures. Under this new system, over 
time (unfortunately in many cases 20-30 years) the patient's share of 
the total bill will return from today's average of 50-50 to the normal 
Medicare co-payment of 20%. The establishment of this system will also 
make it easier for consumers to know what the price for a procedure at 
a particular institution really is. The calls by my staff show that, if 
one has a non-emergency medical need, some calling around can save 
literally thousands of dollars. But this information comparing costs 
between hospitals and other settings where the procedure can be done 
(such as an ambulatory surgical center where it is being proposed to 
allow lithotripsy to be done) should be more easily available.
  I hope that in this age of the Internet and other easier information 
gathering sources that we will find ways to make this type of basic 
shopping less of a mystery. Other data will be able to tell us the 
quality of different providers. Together, this information can help us 
choose both the quality and the price of the service we seek. This type 
of information can help reduce some of the outrageous costs of the 
American health care system and push the overall system toward higher 
quality.

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                                         Approximate cost of      Approximate doctors
           Name of provider                 facility fees                 cost              Approximate totals
----------------------------------------------------------------------------------------------------------------
1. Johns Hopkins USA (at Bayview):
    A. Self-Pay......................  $2200..................  $2100..................  Procedure $5300
    B. Medicare......................  .......................  .......................  Price changed from call
                                                                                          made previously--now
                                                                                          is $5400. Medicare
                                                                                          would cover 80% so
                                                                                          patients pay $1080.
                                                                                          Anesthesia is separate
                                                                                          and very hard to
                                                                                          determine--`can't
                                                                                          answer,' because cost
                                                                                          depends on individual
                                                                                          procedure.
2. Bethesda, Maryland Urologist Group
 Practice:
    A. Self-Pay......................  .......................  Initially, office        .......................
                                                                 policy to not give
                                                                 price, but then quoted
                                                                 about $3000.
    B. Medicare......................  .......................  Medicare pays 80% of     .......................
                                                                 approved cost.
3. A Maryland Urologist..............  N/A....................  $3500..................  .......................
4. University of VA Medical Center:
    A. Self-Pay......................  UVA is State hospital;   .......................  Estimate from $7000 to
                                        one can get help/                                 $10,000.
                                        discounts eligible for
                                        financial assistance.
    B. Medicare......................  Patient charged 20% of   Said Medicare won't      Was ``impossible'' for
                                        what is approved by      approve all of $10,000.  hospital to get this
                                        Medicare.                                         information; patient
                                                                                          must talk to Medicare
                                                                                          about what is
                                                                                          approved.
5. George Washington University
 Hospital:
    A. Self-Pay......................  .......................  .......................  $9000, 25% discount for
                                                                                          payment up front--[25%
                                                                                          discount is $2250,
                                                                                          which lowers facility
                                                                                          fee to $6750]. This is
                                                                                          a flat fee-paid up
                                                                                          front and there should
                                                                                          be no additional fees,
                                                                                          but doesn't include
                                                                                          anesthesia. Anesthesia
                                                                                          is approximately $409
                                                                                          an hour for this
                                                                                          procedure. The non-
                                                                                          prepaid rate is $630.
    B. Medicare......................  .......................  .......................  Was directed to talk to
                                                                                          Medicare about what
                                                                                          they cover.
6. Georgetown University Medicare      Depends on hospital      Fee during procedure is  Despite repeated calls,
 Center.                                fees. It varies, but     $3800.                   could not get in touch
                                        assume $2000 for each                             with insurance/billing
                                        half-hour--so assume                              department to find out
                                        $4000-$5000 for                                   the cost for Medicare
                                        hospital fees.                                    enrollees.
7. Urologic Surgeons of Washington:
    A. Self-Pay......................  N/A....................  Doctors cost: $3482....  .......................
    B. Medicare......................  .......................  Medicare fee schedule    .......................
                                                                 brings down amount so
                                                                 patient ends up paying
                                                                 approximately $160.
8. Duke University Medical Center:
    A. Self-Pay......................  Facility fees are        Doctors fees are         .......................
                                        approximately $6500.     approximately $2500.
    B. Medicare......................  Hospital accepts what    Need to file claim       .......................
                                        Medicare pays outside    first; then can tell
                                        of deductible ($768).    cost of doctors' fee.
9. Midwest Stone Institution           .......................  .......................  Total costs run from
 (Missouri).                                                                              $8000-12,000. Could
                                                                                          not find out what
                                                                                          Medicare approves.
10. American Kidney Stone Management,  Cannot give cost         .......................  .......................
 Ltd.                                   without knowing which
                                        hospital is performing
                                        operation because
                                        there is ``great
                                        difference between
                                        hospital costs.''.
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