Editor's Corner: A plea for price transparency for all

Editor's corner
Ron Shinkman
Ron Shinkman

Religion and healthcare have had their share of clashes recently. The Hobby Lobby Supreme Court decision essentially gave employers an out regarding paying for services that clashed with their religious beliefs. Meanwhile, in California there has been a drawn-out legal battle over the reproductive services one of its biggest hospital systems, San Francisco-based Dignity Health, should offer without offending the sensibilities of the Catholic church.

There are some sects that are more flexible regarding their religious beliefs--and in some ways they drive badly needed transparency in healthcare costs.

The Amish and Mennonites come to mind. They're sects with a combined population of about 380,000 who reside mostly in Pennsylvania and some Midwest states. Despite the fact that their religious beliefs forbid the embrace of advanced technologies, many Amish and Mennonites actually do undergo medical procedures that have only been around for the past few decades, such as open heart surgery (although most avoid care for the very old or terminally ill that only prolongs the inevitable terminal illnesses).

But both the Amish and Mennonites are also exempt from paying tax penalties for not having health insurance under the Affordable Care Act. When they do need healthcare services, they usually pay cash upfront, although they do have forms of mutual aid pools that indemnify members who need very expensive treatments. That has prompted a handful of hospitals to cater specifically to that population.

Side Effects reports that Putnam County Memorial Hospital in Missouri offers prices upfront for their care--a wise business move given there are more than 20,000 Mennonites and Amish in Missouri alone. That occurred after locals--many of whom have traveled to Mexico and other countries for cheaper healthcare services--approached the hospital and asked what they could do.

WellSpan Health's Ephrata Community Hospital in Lancaster, Pennsylvania is another hospital that caters to the Amish and Mennonites. Since neither group uses the Internet, Ephrata annually prints “The Plain Community Guide to Healthcare Services and Prices” (“Plain Community” is a generic reference to the traditional Amish and Mennonites). It contains prices for about 150 procedures. They're all package prices--there are no surprise medical bills:

  • A knee replacement is $18,200; a hip replacement is $18,500.
  • A hernia surgery ranges from about $4,300 to $6,200, depending on the type of hernia and the procedure used to repair it.
  • A preventive procedure such as a colonoscopy is $1,800.
  • An outpatient appendectomy is $4,900.

Those prices are well below what you would see on a typical hospital chargemaster and more in line with what organizations charge commercial carriers.

Such a price list for the rest of America's hospitals appear about as often as a Plain Community elder tooling around in a Corvette.

Of course, hospitals in my native Los Angeles aren't offering such a price list; the concentration of frugal, relatively prosperous patients who are willing to pay cash upfront is thin at the very best.

Nevertheless, the proportion of cash-paying patients is only going to increase  as deductibles and co-payments continue to grow as part of the insurance sector's relentless cost-shifting. There are simply going to have to be more Putnam County and Ephrata Hospitals willing to be transparent on what they charge. Or a lot more patients are going to wind up having to get religion. – Ron (@FierceHealth)