Behind the hospital bill: Will revealing prices--which are all over the place--send patients surgery shopping?

• Author: Martin, Edward

BY EDWARD MARTIN

With winter over, affluent second-home owners were returning to the wynds, as they call the narrow streets on Bald Head Island, and to Maritime Market. After slicing deli meats and helping customers all day, Robert Caser changed roles. "Everybody pitches in to help clean up," he says. The next day, he felt a stabbing pain in his left side. Maybe he had stretched awkwardly while sweeping and mopping the produce, baked goods and seafood aisles. Tests at an urgent-care center indicated a pulled muscle, and he was sent home with a prescription for ibuprofen and a bill for $120. The pain persisted. Two days later, he'd had enough. "I came home from work and told my wife, 'Honey, I'm going to the hospital. Maybe they missed something.'"

Caser, 55, drove the 8 miles from his home in Boiling Spring Lakes to Dosher Memorial Hospital in Southport, where emergency-room doctors told him they could give him a shot for the pain but, if they did, he couldn't drive. "I'd have to get a cab home and then get a cab back to pick up my car the next day, so I asked how much it would be if I stayed." He repeated the question during each test they gave him. "I never got a straight answer." He left the next morning with the diagnosis of a pulled muscle confirmed.

He learned how much a few days later. "I came home from work and my wife was freaking out. She said, 'What are we going to do?'" The bill was for $13,939.13. Liability concerns, Dosher administrators say, obligated the hospital to give Caser multiple tests to rule out more serious causes of the pain. Besides, doctors and nurses typically don't know the costs. Had he known, Caser says, he would have gone home and stayed there until he recovered.

It was a jolting introduction to the mysterious world of health-care pricing, where clarity in what hospitals charge has been as elusive as cures for many of the diseases that put people in them. Cost of care traditionally has been clouded by impenetrable complexities of health-care finance, vagaries of human illness and injury and hospital policies such as Dosher's that, well-intended or not, spark outrage among patients. Now, though, a state law Gov. Pat McCrory signed in August and, separately, a provision of the Affordable Care Act that became effective 10 months ago is prodding transparency in hospital pricing. The ACA measure opened to the public a massive database on what the nation's 3,000 hospitals charge for 100 frequently performed operations and procedures.

Some hospitals, including those of Charlotte-based Carolinas HealthCare System, Greensboro-based Cone Health and Wake Forest Medical Center in Winston-Salem, already have mechanisms that allow patients to determine their out-of-pocket costs. The state's largest health insurer, Chapel Hill-based Blue Cross and Blue Shield of North Carolina Inc., provides its members similar information. The two new laws, however, promise to bare hospital charges to an extent unimaginable I generation ago, with far-reaching consequences.

Consumers and employers, indoctrinated that it's gauche to question cost when health is at stake, will find price transparency the second half of an equation that could alter fundamental hospital decisions. The first, firmly entrenched, has been a flood of information the last five Years or so on hospital quality, such as Hospital Compare data from the federal Centers for Medicare & Medicaid Services, a key source of BUSINESS NORTH CAROLINA'S annual hospital ratings (page 50), and the state hospital association's North Carolina Hospital Quality Center.

Together, they could for the first time bring rhyme and reason to bills Tar Heels receive for the 4.6 million days they spend in hospitals each year. "The combination of price data and quality data can empower them and alleviate concerns that low price is associated with low quality," says...