Price Transparency: West Virginia Gets It Done

At some point in the future, I'll need a total knee replacement (TKR).

The patchworked result of an MVA, Franken-knee has already cost me (and various insurers) a pretty penny. So it's reasonable to wonder how much more me and the ol' insurance card will be shelling out (approximately) for a major joint replacement surgery.

Now, I could spend many moons beating my head against the wall trying to make sense of old billing statements from MD/DC hospitals.

Or I can pony up, jump on the healthcare consumerism bandwagon, comparison shop and arrange for a little medical tourism. Where would I consider heading for a TKR? West Virginia.

I'm in good company - WVa Governor Manchin had knee replacement surgery last year.

And you read that right - ol' WVa shot to the top of my list this week (top 10 at least) when I read this article by Eric Eyre, published in The Charleston Gazette and summarized in the Health IT Strategist daily HITS e-newsletter.

With five minutes (or less) of web browsing, I can find out how much a 'common' major joint replacement surgery may cost (an 'average' price, not an 'exact' one) at hospitals across the state.

The West Virginia Healthcare Authority developed the list of procedures and pricing, complete with hospital websites and phone numbers. It's easy to use (and also a bit addictive).

Why publish this information? According to CompareCareWV the number one reason is that "consumers are requesting it." Click here to read the complete info section for health professionals.

Although the site doesn't currently include quality ratings (just links to outside sources reporting QRs like Leapfrog, WVa Hospital Association, and AHRQ), WVHA plans to add these later.

Here are the steps I followed to get a very rough major joint replacement 'quote' of "Average Total Charges" ranging from $21,356.00 (St. Joseph's Buckhannon) to $47,070.00 (Raleigh General).

That's a difference of $25, 714. Click here to view my results.

1. Visit www.comparecarewv.gov.

2. Choose either "Procedure" or "Hospital" from the opening paragraph - click through.

3. I chose "Procedure," and then selected "Muscles, Bones, and Joints" from the dropdown menu under "condition, body part, or system affected."

4. I chose "Major Joint Replacement" for "specific medical service" (another dropdown menu - it didn't allow me to specify shoulder, knee, hip, etc).

5. I entered my zip code (outside WVa), clicked on the circle for "any" distance away, and then selected "all" the hospitals that appeared in dropdown menu 4, "Select WV Hospitals by Name."

Where is the data coming from?

"The average gross charge is calculated from State payor claims data including PEIA, Medicaid and other state payors. We have utilized publicly available claims grouping software tools to aggregate procedures to commonly termed reimbursed items. These groupers include the CMS Diagnosis Related Group (DRG) grouper and the AHRQ Clinical Classification Software (CCS) grouper.

Data are dependent on the accuracy and completeness of the data submitted by the payors. Data collection may not be the same for all payors. There may be some variability in assigning diagnoses and categorizing the amounts for the claims."

What should facilities expect as a result?

"Facilities may receive inquiry about gross charges from consumers or other professionals. These contacts may be an opportunity to expand the patient base or to initiate patient services activity within the revenue cycle. Providers can view this publication as a tool to assist patients and professionals with decision making."

How does your hospital's pricing transparency compare?

If an entire state can mobilize resources to make this data available, can't you?


CAP said...

Jen - nice post!
Just as an FYI: we're launching www.findyourdoc.com (on CA and TN are loaded right now, and the UI is getting redone in about 3 wks) but it has price, negot rate, and hco cost.

your total hip was under 209 (now DRG 544) and for Raleigh General it shows....
Cases: 96
ALOS: 4.8
Avg chrgs: $46,812
avg negot rate: $14,346
avg hco cost: $9,564

Just thought you'd have fun seeing it and then seeing how it improves in 40-45 days after the complete re-design


Sheethal said...

Most people are aware of the total knee replacement surgery. This involves replacing the unhealthy surface of the entire knee joint with metal and plastic implants. It is a very successful operation with good long term results. However a large percentage of patients have arthritis limited to one part of the joint alone. Replacing the whole joint in these patients is overkill and unnecessary.Many middle aged men and women develop osteoarthritis of the knee. Osteoarthritis of the knee affects the inner half or medial compartment to start with and then proceeds to affect the outer half or lateral compartment.
In this operation only that part of the knee, which is unhealthy, is replaced. The normal surfaces are left alone. This operation has several advantages over total knee replacement surgery.It can be done through a very small incision.
It is minimally invasive and hence tissue damage is far less. The patient gets complete pain relief and the implant lasts long The knee feels more natural as ligaments are preserved Range of movement is full and it allows squatting and sitting crosslegged Post operative hospitalization is reduced and return to normal is much faster than total knee replacement surgery. Dr. Kaushal Malhan is a Joint Replacement and sports surgeon at the Wockhardt hospital, India. He was the first surgeon in India to do the mobile bearing oxford unicompartmental knee replacement and has been in the forefront in the field of full bending knee replacement surgery. many International patients have benigiited from this.. please visit the link below to read the expiences.