Most people don't worry about the cost of hospital procedures because they have some form of health insurance or because they are covered by Medicaid or Medicare. Some people aren't so lucky.
Me, for example.
I needed a ''2-D, M-mode echocardiogram with color flow Doppler.'' My physician had his assistant schedule this procedure at St. Agnes Cardiac Diagnostic Center. Because I have no insurance I had her ask the center how much the procedure would cost. Including the doctor's or technician's reading, it would cost $785.
I decided to go shopping. I called several hospitals in Baltimore and compared prices. I was stunned at the variety of responses, lack of responses and the price range for this procedure. My quest involved approximately 100 phone calls to 15 hospitals, plus doctor's offices, state agencies, private businesses and Maryland legislators.
One should never base a medical choice completely on financial considerations. But the physicians and technicians at all these hospitals are qualified to perform this test.
The lowest price was Church Home Hospital which quoted $189.03 for the procedure and an additional $168 for the physician's reading. The most expensive was Johns Hopkins Hospital with an inclusive rate of $1,010.
Comparing prices is difficult. I encountered all types of personalities, mentalities and problems. At St. Joseph's and St. Agnes hospitals it was relatively easy to get full information. Every other hospital required a minimum of four calls.
Greater Baltimore Medical Center can quote prices for the the procedure, but not the physician's reading because it has contracts with a variety of physicians. The cost of reading depends on the time and day of the procedure. But the hospital will not tell which is the cheapest or most reasonable doctor.
Many of the hospitals would connect me with accounting or billing, where I would hear something like this, from Sinai: ''All I can tell you is we make a payment schedule after it is done.''
Johns Hopkins quoted me a price from the department where the test would take place -- with the caveat that it was out of date and should be checked with the billing department. The billing department said it did not have access to a procedure's cost and suggested I talk with admitting. Admitting suggested the physician's referral office.
By this time I was annoyed and decided to deal with the public-relations department, which was too busy to help. Eventually my call was returned, but public relations, too, would not quote a price and suggested a call to the hospital social worker.
The social worker could not give me this information. I called back public relations, which promised to find out the price.
Obviously I have no intention of going to this hospital. The bureaucracy frightens me.
Why is there such a discrepancy in price? Why aren't prices regulated? According to the person I talked with at the Health Services Cost Review Commission, costs are regulated for inpatient but not for outpatient procedures.
How are prices for a procedure determined? Since Blue Cross/ Blue Shield covers hospital procedures throughout the state, I decided to inquire there. Again I was transferred from department to department. When I asked to speak with Bill Jews, the president of the organization, I was finally connected with someone in marketing who offered to find out what I wanted to know.
Days later Lisa Wilsong courteously replied that, according to her source (who prefers not to be named), the Health Services Cost Review Commission does regulate all inpatient and outpatient procedures. This is contrary to the information I had received from the commission itself.
So I called Bob Murray, the commission's executive director, He cleared up misinformation I had received earlier from his agency. The commission does indeed regulate both inpatient and outpatient hospital services, he said. In the past outpatient costs were not regulated as stringently as inpatient proced- ures. There was a presumption that a market existed outside hospitals for outpatient care in the many freestanding ambulatory centers.
Hospital price regulation is too large a subject to be described fully here, but it includes charges which are set for various departments in a hospital, such as critical and intensive care. Various markups reflect whether the hospital is a teaching institution or how much uncompensated care is provided. Approximately 20 to 25 percent of a hospital's revenues are generated by outpatient services. The Health Services Cost Review Commission has not developed the same level of scrutiny and mechanisms that were available for setting rates for inpatient costs.
Most consumers are not as persistent as I am. How do they make decisions? Do they just let the doctor handle everything? What happens when the bills start arriving? Do they pay them and postpone the mortgage? Do they ignore them?
As smart consumers, we would never pay $100 more for the same-quality muffler. But people can't shop without proper information. Restaurant menus list prices next to each item. Why vTC then do we let the hospital industry indulge in anti-competitive actions to keep us from shopping?
Don't be docile. Check prices. If 100 phone calls sounds daunting, call me and I'll do it for you.
Michele Rosenberg writes from Baltimore.