Worcester County patients pay less for MRIs, health care cost study finds

July 18--Worcester County health care consumers may be getting a better deal -- at least for an MRI -- than those in other parts of the state, according to a study released Wednesday by the Pioneer Institute.

An analysis by the nonprofit public policy research organization of insurance claims data filed with the state Center for Health Information and Analysis shows it pays to shop around. The health policy brief, titled "Need an MRI? In Worcester, Patients Pay Less for More," is the first of a series of reports based on claims data, demonstrating the benefits that access to health care data can have for consumers, according to its author.

Looking at insurance claims for a single common imaging procedure, MRI of the knee, Pioneer researcher Scott Haller found that the average out-of-pocket cost paid by patients for an MRI in Worcester County was $59.60, 60 percent below the state average.

The highest average out-of-pocket cost, $175.74, was in Berkshire County. Boston's Suffolk County average was $75, while in MetroWest, Middlesex and Norfolk counties averaged a little more than $90.

The study looked only at payments for charges from the imaging facility and did not include radiologists' charges for interpreting the knee MRI images.

Out-of-pocket costs are what consumers pay for health care services not paid for by their insurance company. These costs typically include fixed co-payments for a service; co-insurance that requires a patient to pay a percentage of health service costs; and deductibles, the amount of health care costs to be paid by the patient until the insurance coverage kicks in, up to an annual maximum.

With more people having high-deductible insurance plans these days in exchange for lower premiums, consumers can find themselves paying thousands of dollars out of pocket for care.

Consumers would not only save themselves money when choosing lower-cost providers, according to Mr. Haller. But in the long term, he said in an interview, "If the whole state starts choosing lower-cost providers, premiums will start to moderate."

The Pioneer analysis shows wide variation across the state for a routine procedure in allowed charges -- the amount agreed to by an imaging facility and the insurance company -- as well as the out-of-pocket costs, which may reflect the design of different insurance plans.

The allowed amount for an MRI in Worcester County averaged $298.86, with a maximum allowed amount of $2,563.70.

Nantucket, with one hospital and limited options for patients, had an average allowed charge of $1,786.96, and a maximum allowed amount of $3,193.21.

The highest maximum allowed amount in the state, $4,724, was in Suffolk County.

Mr. Haller said the analysis did not distinguish between MRIs provided in hospital-based facilities and those that were in freestanding imaging centers.

A state law, Chapter 224 of the Acts of 2012, was intended to make health care costs more transparent so market forces, through price-conscious purchasers, could slow the rate of cost increases. The law required disclosure of pricing information by all medical providers and insurers in the state, and set up quasi-independent state agencies such as the Health Policy Commission and the Center for Health Information and Analysis to monitor cost trends, according to the Pioneer health policy brief.

A consumer can telephone a medical provider beforehand to get at least a standard estimate of a procedure's cost, under the law, or use tools provided by their health plan to find out what costs may be incurred at different providers.

"The big problem is, consumers just don't know that these tools exist," Mr. Haller said.

Regional health insurance companies are amping up their cost tools to help members comparison shop when choosing medical providers.

Carrie Wattu, spokesperson for Worcester-based Fallon Health, wrote in an email that in October 2014, Fallon became the first in Massachusetts to include prices for medical procedures and tests on its website.

"Fallon is also unique in Massachusetts in that in addition to providing the information, we also make incentives available with our transparency tool. Our goal is to educate and empower members to choose the care that is right for them, and help members to save money on procedures while earning incentives," she wrote.

Fallon's consumer cost tools, Smart Shopper and Smart Choice, are available to commercial members to help them decide how to spend their health care dollars and where to have services performed, according to Ms. Wattu. Smart Shopper offers a cash incentive to members.

Rick O'Connor, chief marketing and communications officer for Harvard Pilgrim Health Care, said the insurer offers a suite of health insurance decision tools.

MyHealthMath, offered to Harvard Pilgrim employer customers, helps employees select the plan that gives them the best value. It starts with one-on-one personal health usage interviews, and then uses a proprietary algorithm to identify the financially optimal health plan for consumers, he wrote in an email.

Estimate My Cost lets members estimate health care costs for more than 800 services in Harvard Pilgrim's network of providers -- before they receive services.

Reduce My Costs, known formally as SaveOn until September, is a voluntary program that lets members save money by finding care at a lower-cost facility for elective, outpatient medical procedures and diagnostic tests. This is a phone-based service. If a member chooses to and receives care from a lower-cost provider, he or she will earn a cash reward.

Mr. O'Connor said in an interview that those who have used the services are "very highly satisfied."

In particular, members who have called SaveOn found, "It really does help you shop around in a more intimate setting," Mr. O'Connor said. "We call our tools technology with a human touch."

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