The perils of price lists for private practices
The details of what will come when the Affordable Care Act is repealed are not yet finalized, however high on President Donald Trump's list on healthcare reform is the idea that patients should have the ability to compare prices before they decide on a doctor or facility for their healthcare.
Further reading: What the Obamacare repeal bill means for physicians
But the question remains—can doctors actually provide their patients with a price list?
“Sure we can,” says Ripley R. Hollister, MD, a family physician with a practice in Colorado Springs, Colorado, and a board member with the Physicians Foundation, which provides support and research to help physicians deliver high quality, cost-efficient healthcare. “We all have a pricing schedule—we know what are prices are based on CPT codes. So if I have a health maintenance visit with a patient between the ages of 40 and 64, there’s a code for that. A rapid strep test, there’s a code for that.”
Some practices already post these prices on their websites, but the costs listed are not necessarily what the patient will pay. Patients with health insurance, for example, pay only what the insurance does not cover.
“The most important decision is whether a practice accepts health insurance or not,” says Nitin S. Damle, MD, MS, MACP, president of the board of regents of the American College of Physicians and the managing partner of South County Internal Medicine in Rhode Island.
Not all practices accept insurance, practicing direct pay instead.
“At present, about 5 to 6% of practices do not accept insurance,” he says. “The patients may pay on a pure fee-for-service basis, or there may be a monthly payment irrespective of office visits, or there may be a retainer, or some combination of all of the above.” Many of these doctors make deals with patients on an individual basis, providing pricing one-on-one based on the patient’s specific needs.
If practices that accept insurance publish their fee schedules, they will not reflect what the patient will actually pay, Damle explains. “So price list is less relevant, in that those are not actual payment in most cases,” he says. “If the practice does not accept insurance, then it is appropriate to disclose the cost of services.”