To: Health Care Quality and Cost Council Members
From: Gregory W. Sullivan, Inspector General
Date: May 18, 2007
Subject: New Hampshire Health Cost Website Review

Our office reviewed the State of New Hampshire NH HealthCost website. We experimented with a number of different health plans, deductibles, co-pays and various medical/surgical procedures to obtain the information presented in this review. We were impressed with the comprehensive data available and the simplicity of using the website to obtain detailed cost estimates. It was particularly useful in comparing the prices per procedure, per health plan and per hospital as requested, with specific payment estimates including deductibles and co-pays for the consumer and their insurance plans.

As we all know, Chapter 58 does not permit the publication of costs as specific as the cost estimates available in New Hampshire- Ch. 58, Section 136 "... Cost information shall include, at a minimum, the average payment for each service or category o(f) service received by each facility, clinician or physician practice on behalf of insured patients. Cost information shall be aggregated for all insurers and the council shall not publicly release the payment rates of any individual insurers which shall not be deemed to be public record. "

Following our upcoming discussions with officials from New Hampshire on the process used to obtain this data and the feedback from consumers, providers and insurers about the website, we may want to examine this limitation in Chapter 58 and consider offering changes to the section.


Background

The state of New Hampshire has developed a health care cost transparency website. The website, known as NH Health Cost (www.nhhealthcost.org), is quite comprehensive, very informative and easy to use. It was developed by the NH Insurance Department, the Commissioner's Advisory Committee on Health Insurance, the NH Health Information Center, and the NH Institute for Health Policy and Practice, beginning in 2005.

Website Features

Anyone can access and use the NH Health Cost website which you can enter by identifying whether or not you are insured, entering a New Hampshire zip code, selecting the desired medical/surgical service or procedure, indicating the comparison service area in miles, and identifying your health insurance carrier and particular plan (together with deductible and co-pay requirements). The website will then present a list of hospitals and other providers within the. identified travel radius who offer the chosen procedure and have sufficient utilization data to produce a cost comparison. The detailed cost estimates listed are also rated by precision or reliability of the estimate, as well as a risk adjustment value on the complexity of the patient mix for that condition in that particular hospital, etc. Another feature breaks down the total payment to the hospital by the consumer and the insurer depending on the health plan and deductible and/or co-pay. There is also a feature that provides cost estimates to consumers who are uninsured.

The website presents cost estimate information in five major areas: Preventive Health, Emergency Visits, Radiology, Surgical Procedures and Maternity, with many subcategories. For the purposes of this review we chose a number of procedures and have compared the costs by different health plans, i.e., Harvard, Cigna, Anthem, etc.; and in some cases, within health plans, i.e., Harvard's HMO, Harvard's PPO, etc., using sample deductibles and co-pay amounts. The findings were quite remarkable and varied by health plan. In the hands of a consumer, this information could most likely lead to comparison shopping among provider choices (and even health plans). However, since no quality information is offered on this website, consumers cannot yet compare that important factor in making their informed health care choices.

Selected Procedures

Cost information is presented on the following 7 selected services from the website:

  1. Colonoscopy
  2. Arthroscopic Knee Surgery
  3. Kidney Stone Removal
  4. Emergency Room Visit- Medium
  5. Vaginal Birth and New Baby
  6. Chest X-Ray
  7. MRI- Knee

Asterisked (*) sections of the data draw your attention to the variable ratings (precision of cost estimate and typical patient complexity), to produce the best apples to apples comparisons in each category considering these variables. For uninsured consumers, the data presents a median charge for the procedure/service and then the median charge with a 15% discount, which state officials determined was typical of NH hospitals to offer to the uninsured. A nice feature of the website was that after each presentation of hospital costs, the phone number of the hospital was included for consumer convenience and follow-up.

Cost Range Observations in Selected Categories
Our review considered each category and compared only selected examples with "High" precision of cost estimate and "Medium" patient complexity for each health plan, to make the comparisons as fair as possible.

  • Colonoscopy costs, with similar cost estimate precision ratings and patient complexity values for an area within 50 miles of Portsmouth, NH, range between $991 and $2,591 depending on the health plan and the hospital/center. Discounted uninsured rates for a colonoscopy ranged slightly higher from $1,345 to $2,916 depending on the hospital. For one provider, the price more than doubles ( $991 to $2,018) with the same cost variables ratings and patient risk factors, depending on the health plan.
  • Arthroscopic knee surgery with similar variables for insured individuals, range from $4,811 to $9,213, with uninsured rates ranging in the same area; $4,910 to $9,509. An example of variance in charges we observed included one provider charging different health plans charges ranging from $4,811, $5,449, $5,491, and $9,213 for the same procedure with the same variable ratings.
  • Kidney stone removal for the insured range from $6,141 to $10,086 with the more expensive uninsured costs ranging from $7,622 to $16,402. One provider charged consumers from $6,141 to $10,862 for the same procedure depending on their choice of health plan (even with the same deductible and co-pay levels).
  • Emergency room visits of a medium nature (versus very minor nature) with similar variables range in cost from a low of $399 to high of $836 for the insured, depending on the provider and the health plan. Uninsured rates for the same emergency room visits range between $293 and $899.
  • The vaginal birth and new baby category presented a very wide range of costs starting at a low of $5,058 to a high of $12,817 for similar cost precision and patient mix values for insured individuals within 50 miles of Portsmouth. Uninsured rates for the same procedure range from $6,755 to $13,498. Depending on the health plan the consumer purchased, the total cost of having a baby at one provider institution ranged from $ 5,058 to $7,479.