Dr. Jon Hallberg: The huge cost variation of medical treatment

The price for an appendectomy at hospitals in California can range from $1,500 to $180,000, according to a recent study in the Archives of Internal Medicine.

MPR's medical analyst Dr. Jon Hallberg discussed the huge variations in prices for treatment at U.S. hospitals with Tom Crann of All Things Considered on Wednesday. Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic.

An edited transcript of that discussion is below.

Tom Crann: Right off the bat, do doctors in the clinic have anything to do with those prices we see on statements from our insurers?

Dr. Jon Hallberg: Not at all. And I certainly don't want to get us off the hook and just plead ignorance, but we honestly don't know what a lot of things cost that we charge for. The one thing we have control over is what we circle on that billing slip in terms of the level of the visit or the complexity. That's something we have to think about, so you have some control of that but the actual cost we don't.

Crann: How often would you say that patients are coming in with questions or concerns about their bills or costs of procedures?

Hallberg: Much too often. This is something I'm certainly seeing more now than I did ... 5 to 10 years ago. And I think there's all kinds of reasons behind that. When I open that clinic exam door and I see the bill on the table, I know we're in for a long conversation.

Crann: What about referrals, sometimes you have to have a visit with a doctor just to get the referral ... Can you make referrals in other ways?

Hallberg: I think people worry we primary care providers are gatekeepers. I really hate that term because it really implies that we're keeping people from the care they need. If we think about it as a coordinated role though, it makes a lot more sense. For example, if someone has back pain and they call the clinic and they want an MRI for pain that's been around for two or three days, that's a completely inappropriate use of money. There should be a role where I actually see that person. If we've talked about back pain and two weeks later they decided they want to go ahead with the MRI, we can talk care of it over the phone and save a visit.

Crann: More and more people have health savings accounts. They have to make the payments for things. Do you find yourself having conversations with patients ... to try to keep these payments down?

Hallberg: Sure, and I think we're doing more and more monitoring from home. If people have high blood pressure, they can buy a cuff, a really good cuff, and send me an Excel spreadsheet, or call the numbers in or drop them off, and we can look at them and make some changes over the phone. This is good medicine, I don't think that's even that we're trying to save money for somebody, but it makes sense to do more of that. It would be nice to get reimbursed for that, and maybe we can do that at some time down the road, but we're making a lot of accommodations.

Crann: Is there anything as a doctor that you would like patients to know about this that most of them are [not] aware of?

Hallberg: The thing that comes back to haunt us, months or weeks later after the visit, is there wasn't a clear discussion about what was happening. Great example in primary care, people will come in with a list of questions, we'll go through everything, and at the very end or even months later, they'll say, 'That was supposed to be a physical.' ... I think it's incredibly important that at the outset, you have a conversation with your provider about what you want to accomplish on that visit.

Crann: Do you see anywhere on the horizon, more of a standardized system about what things cost or the way they're presented ... that might make this easier to deal with?

Hallberg: As long as we have the medical groups and the hospital groups and the insurers all in these different camps, it's all about negotiated price, it's about who can buy the best deal and bring it down. That's the problem. And as long as we have this sort of multi-system system, I'm not sure i can see a simple solution to that.

Interview transcribed and edited by Jon Collins, MPR reporter.

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