You can’t always shop around when it comes to your medical care. The back of an ambulance is no place to start Googling hospitals to find out which one provides the best and most affordable treatment for the heart attack you’re experiencing.
But when you can plan ahead — think an elective procedure or imaging test — it often pays to do your homework.
The state has launched a new website designed to help consumers learn how much Maine health providers charge for common procedures and how they stack up on the quality of that care.
CompareMaine.org allows users to research the typical costs for more than 200 medical procedures at more than 170 medical facilities across the state. The site reflects the median amount* (more on this below) paid by insured individuals who have coverage through the state’s private health insurance companies.
Visitors can also compare quality ratings for many health providers.
Let’s take gallbladder removal surgery as an example. The cost ranges from $9,789 at Redington-Fairview General Hospital in Skowhegan to nearly $23,000 at The Aroostook Medical Center in Presque Isle. The state average for that procedure clocks in at about $13,000.
Is the more expensive option better? Very often, no. Research shows that cost is a poor indicator of the quality of care patients can expect.
CompareMaine.org is one of only two state health care comparison sites that present quality ratings alongside cost information, according to the state.
“In Maine and across the nation, there can be large differences in the cost and quality for the same health care service. You may pay a lot more for the same procedure depending on where you go,” Gov. Paul LePage said in a news release announcing the new site. “Many of us are paying higher out of pocket costs for our health care services. I hope that by making this information available, consumers and employers will be positioned to make better informed decisions.”
The Maine Health Data Organization created the site using federal grant funding, in collaboration with the Human Services Research Institute in Massachusetts, NORC at the University of Chicago, and Minneapolis web designer Wowza. The site pulls cost information from health insurance claims that MHDO collects from insurers. The quality data is based on several state and national sources.
What CompareMaine.org shows:
- Typical costs for nearly 200 common procedures, such as chest X-rays, cholesterol blood tests and knee replacements, in eight categories: office visits, physical and occupational therapy, integrative medicine, mental and behavioral health services, obstetric and gynecological procedures, radiology and imaging, laboratory services, and inpatient and outpatient surgery. Search by facility or choose from five different health insurers.
- Prices charged by hospitals, labs, imaging centers, surgical centers, clinics, and physician practices.
- Quality ratings that shed light on how satisfied patients are with their care and how well the facility prevents both serious complications and two common infections that can result from hospital stays.
What CompareMaine.org doesn’t show:
- Exactly how much you’ll pay for a procedure — don’t count on the site to predict your medical bill. CompareMaine.org shows typical costs, but yours will vary depending on whether you have insurance and how much you pay out of pocket (deductibles, co-pays and co-insurance) under your plan. Use the information to inform yourself before calling your insurance company or health provider for specifics.
- *Let’s get back to that asterisk. The site displays “average costs” for various procedures, but it uses “the median value rather than the mean to come up with the average cost.” Anyone else hearing their high school math teacher lecturing about how a median and an average are two different calculations? I did too. (Shout out to Mr. Birkel and Mr. Mooers at Bangor High). After speaking with MHDO’s acting director, Karynlee Harrington, I learned that the site actually displays median costs (the middle value when all items in a sample are sorted from lowest to highest) but it describes them as averages. A consumer advisory group thought the term “median” wasn’t user-friendly enough, she said.
- Cost and quality information for individual doctors. You can’t look up your family physician or surgeon by name. State law allows MHDO to report that though, so the agency may add the information later.
- Data for emergency room visits. MHDO plans to include that in the future.
- Costs for people with MaineCare and Medicare (more than a third of the state’s population). The claims database MHDO oversees pulls only from private health insurers, not government-sponsored insurance. Still, that leaves the site with more than 10 million claims from 47 payers.
What if you don’t have insurance? As of Jan. 1, 2014, a provision in the Affordable Care Act requires health providers to charge uninsured people the average cost that the providers have negotiated with top insurance plans. That should help you to estimate your own costs using the site.
Other websites worth checking out:
- Visit the GetBetterMaine website to see how physician practices rate on several quality metrics — care for diabetes, heart disease and high blood pressure, as well as preventing medical errors.
- Check out Maine Patient Experience Matters to review public patient survey results on the doctor you have in mind.