Good news: Comparing fees for many medical services will be easier in 2021. And understanding what is a shoppable service for healthcare may help reduce costs.
When you think about shopping for a service you need, countless examples come to mind. You’ve probably comparison shopped, often online, for a host of different services, from lawn care to computer repair and everything in between.
Unfortunately, shopping for one of the most important aspects of life, medical services, can be far more difficult.
In fact, you may not be aware there are shoppable services for healthcare because finding information about which services are, by definition, “shoppable,” and how to find and compare prices can be difficult and almost impossible.
But comparison shopping for hundreds of tests and procedures is set to become easier next year, and that could help lower healthcare expenses.
What are shoppable services for healthcare, exactly?
The answer to “what is a shoppable service for healthcare?” involves a specific medical service you can schedule well ahead of time, usually on an out-patient basis.
Obviously, that means many healthcare services aren’t “shoppable.” You can’t plan ahead for treatment for a broken bone, heart attack, or other emergency, for example. And you may have no idea you need certain tests, like an x-ray or blood tests, until your doctor notes a potentially serious problem during an exam, and orders immediate testing.
Hundreds of tests and procedures, however, do fit the definition of shoppable services. For instance, lab tests for a chronic condition or a cholesterol level check, colonoscopies, yearly mammograms, and imaging tests, like MRIs, CT scans, and echocardiograms, can all be scheduled on an out-patient basis (if not needed due to an emergency).
If you have a high-deductible insurance policy, your insurer has in-network providers with varying co-pay requirements at different medical facilities, or you don’t have health insurance at present, it makes sense to compare prices. In fact, it’s a good idea for anyone watching their healthcare expenses to understand what is a shoppable service for healthcare because prices can vary significantly among medical facilities.
Currently, however, it’s difficult for patients to find prices listed for shoppable services. What’s more, according to the Health Care Cost Institute (HCCI), it’s also not easy to learn the full cost of services before receiving them, making it nearly impossible to opt for lower-cost services or providers, even when you are scheduling a procedure well in advance.
In a move toward more transparency in healthcare, that’s set to change.
Making comparing prices for shoppable services for healthcare easier
You can’t realistically shop for a healthcare service unless you are able to compare the cost of the test or procedure you need (along with location and other information) to that of other providers offering the same service in your area, the HCCI points out.
And that will become a reality in 2021 when the federal rule goes into effect (and sooner, in some cases, as healthcare providers prepare for next year. According to the regulation, the Centers for Medicare and Medicaid Services (CMS) will require hospitals to list the prices for 70 specific shoppable services; hospitals can choose the other 230 they list. If a small hospital doesn’t provide 300 shoppable services, it still has to list all the shoppable services it does provide.
CMS’s list of 70 services that hospitals must display prices publicly includes common doctor services like physicals and new patient visits, laboratory and pathology services, radiology and other imaging services, and additional common medical and surgical procedures you can schedule ahead of time.
Hospitals must also make public the charges they negotiate with insurance companies for these healthcare services (so you can know how much your out-of-pocket fee can be) and the amount the hospital is willing to accept if you pay cash. What’s more, charges that typically go along with a service — for example, a pathologist’s fee for examining a polyp removed during a colonoscopy — must be listed, too.
The CMS requires the information to be easy to understand, quick to locate online, free of charge to access, and without any requirements to register, have an account, or enter a password. The list of prices must also be searchable in multiple ways, including by billing codes and descriptions of the type of service.
Bottom line: The required price disclosures will make shoppable services for healthcare truly “shoppable.” You’ll be able to make direct price comparisons to find the best choice for you, depending on your own individual situation.
March 16, 2020