Hi Jon and group,
I’m mostly a lurker in this group but I thought as an “ex-MD” I’d chime in
a little bit. In my opinion, the price differences may be brought on by
several different factors.
First, and I think most importantly, most consumers are insulated from
concerns about price because of insurance. Therefore, the usual market
forces driving people to “vote with their feet” are markedly blunted. As a
result, the providers charge what the market buyers (basically the insurance
companies) will bear. There are not many people who do the kind of
research that you did here, and even fewer who will act on that information,
knowing that they will only pay at most 20% of the amount charged.
Second, the great majority of patients tend to blindly follow their primary
physician’s recommendations. Very few docs are going to be willing to send
their patients out of the area, and even fewer of those actually are aware of
the cost differentials. So, that doctor will refer to his buddy down the
street, not really caring about the cost to the patient and insurance, and the
patient will generally accept that recommendation.
Third, antitrust laws prevent hospitals and physicians from sharing
information about their billing practices and billing rates, so basically, those
entities are relegated to set prices in a vacuum. Of course there are the
informal coffeehouse conferences, but sharing of this information can lead to
severe sanctions from the feds.
The fact that CMS has now released that information is huge, and hopefully,
more consumers like you will become educated and “vote with their feet.”
Thanks for posting, even off topic, and I apologize to the group for using it as
a soap box. Awareness of this problem is the first step to fixing
Of course there are many more factors involved, but this at least scratches
R. Stone Lee