The case of the $517 chest x-ray

The following anecdote is from Dr. Paul Abramson, a physician based in San Francisco, and originally appeared on his blog http://mydoctorsf.com, and is part of a series of posts on this topic

So the story goes like this.  A patient of mine needed a chest x-ray.  He doesn’t have health insurance, so rather than just give him a requisition and send him to the local hospital, I decided to do a little calling around on his behalf to find out what the damage would be… 

Vendor #1: A well-known local hospital

I called up the radiology department and asked them how much a PA and Lateral Chest X-ray would cost.  “I don’t know – we don’t have that information” I was told by the clerk.  The radiologist gave me the same answer.  They both said I should just send the patient over and he would find out the cost when he received the bill.

That seemed a little dumb.  Since when do we go into stores and buy things without knowing the price?

So after 4 additional phone calls and about 2 hours, my assistant and I finally reached Bob who is in charge of uninsured patient billing.  He was able to tell me the price: $517.

For a PA and Lateral Chest x-ray.

For cash paying patients who pay at the time of service and know to ask for the
“20-20″ discount by name, the price ends up being reduced to$310.20. But you have to know the secret code word.

Time to receive report in my office: 2-3 days.

Quality: Good

Vendor #2: Free-Standing Private Radiology Office (call us if you wish to know which one)

I called up and the receiptionist answered on the first ring.  I asked how much for a PA and Lateral Chest x-ray.

An immediate answer: $73.

Time to receive report in my office: 1 hour.

Quality: Just as Good

So my quesiton is this.  How can the hospital be charging 4.25 times as much as the place down the street to cash-paying patients, for the same product and actually inferior response time?   (or 7 times as much without the secret code word).  I know, “cost shifting” is a common refrain.  But that just doesn’t fly any more.

And what’s more disturbing, how can it be so difficult to find out the price when you call up and ask?

So many doctors just send their patients to the hospital x-ray department or lab without thinking that it may bankrupt them.  And many doctors have no idea that the price spread can be so great.

It’s time we developed some more price transparency in health care.  I know there are companies trying to create online price comparison databases.  That is good, but really every entity should be required to have front-line staff know the prices
for every service they offer.  That way patients and doctors can make rational decisions about how to get each patient what they need.