Toledo pays high price for some tests

April 28--Ohio residents are paying well above the national average for some common medical services, such as a breast ultrasound or a CT scan, according to a new analysis from the Health Care Cost Institute.

The group found that overall, though, prices in Ohio for medical screenings and procedures were at or below the national average.

The study, published Wednesday by the Washington nonprofit group, is accompanied by HCCI's National Chartbook of Health Care Prices -- 2015, which shows the differences in prices for more than 240 common medical services in 41 states and the District of Columbia.

According to the report, the costs of individual medical services can vary widely from city to city across Ohio and from state to state.

Last year, for example, the average national price for an ultrasound of the abdomen was $173, while the state average price was $189, but that average price for the same procedure is $548 in the Toledo area.

In another case, the average price in 2015 for a screening mammogram in Toledo was $318, while in Cleveland the average price was $198, and in Columbus the average price was $156.

The information was obtained from insurance-claims data from some of the largest health-insurance companies in the country, including Aetna, Unitedhealthcare, Humana, and Kaiser.

In the past, researchers and others interested in studying the true costs of health care for consumers had to rely mostly on government data from Medicare and Medicaid claims, which have always been open to the public, said David Newman, HCCI's executive director

Private insurance companies have always refused to release the data out of fear it would fall in the hands of their competitors. In 2011, several insurance companies decided to create HCCI and provide the information in a way that it could not be traced back to any individual company, but would still give the public access to the information, Mr. Newman said.

"It's progress. These are clearly numbers from across the country that were previously not available," he said.

Michigan and eight other states were not included in the analysis because of a lack of sufficient data from insurance claims in those states, a spokesman for HCCI said.

Ohio, which has the 17th-highest rate of spending on health care, actually looks pretty good compared to other states, Mr. Newman said.

Ohio spends more on health care overall because there is a high utilization rate, meaning a high number of people are accessing and getting medical care in the state, he said.

Compared to the national average, Alaska has the highest average health care prices, followed by Wisconsin, North Dakota, New Hampshire, and Minnesota.

"It's not to say that everything is perfect in Ohio, but relative to other states that have a price problem, Ohio looks pretty good," Mr. Newman said.

The information released in the HCCI chartbook can also be found on a searchable website, guroo.com. The user-friendly site allows consumers to search for prices of common medical screenings and procedures in their city or state, Mr. Newman said.

The website provides the average price in the person's metro area, the average price in the state, and the average national price for that procedure. The site also can be used to search prices in other cities and states for medical screenings and procedures.

Although the website lists average prices, it doesn't specify costs at different hospitals, doctor offices, or clinics.

The institute is prohibited by Ohio anti-trust laws from making public the prices charged by specific providers or insurance companies, Mr. Newman said.

Some states have passed laws to make it easier for consumers to obtain the information and to promote more transparency in medical pricing, but Ohio is not one of them.

"Some insurers have websites that provide this same information," he said. If so, it's better to use the insurance company's site to get the accurate price information.

Officials at local health-care provider Mercy Health agreed with Mr. Newman that an individual's insurance company has the best and most accurate information about prices.

"Health-care pricing is very complex. What a procedure or service costs out of pocket for consumers is highly dependent on their individual health insurance plan. Mercy Health believes transparency is important and sites like Healthcare Cost Institute's guroo.com can provide some average pricing information as it relates to various procedures and services. However, we also encourage patients to connect directly with a representative at their insurance plan to understand what the actual out of pocket cost would be, as well as what services are covered," Mercy officials said in a written statement.

Officials at the University of Toledo Medical Center, the former Medical College of Ohio, said that instead of a website, the hospital has financial aid counselors who help patients understand what their costs will be for medical procedures.

"We want patients to fully understand what their financial responsibility is when receiving quality health care at UT Health," the hospital said in a written statement.

Officials at ProMedica health-care system said they understand consumers want more price transparency and a friendly process from which to obtain prices.

"Patients have a right to know what their out-of-pocket expenses will be. To that end, we offer a number of tools and resources to help patients manage their healthcare expenses," ProMedica officials said in a written statement.

Those tools include an online cost estimator that uses a patient's specific insurance benefits to calculate out-of-pocket costs, and a patient pricing request form, also available online, which can be used to help determine the patient's expense for nonimaging services.

Despite these tools available to consumers, Mr. Newman said the group's website can be a huge help to consumers by giving them an opportunity to comparison shop.

Contact Marlene Harris-Taylor at: [email protected], 419-724-6091, or on Twitter @marlenetaylor48.

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