Reference pricing has the potential to standardize healthcare costs in the U.S. and empower consumers to make more-informed decisions about their care, according to an article published in the latest issue of the Kurt Salmon Review.
The article was authored by Leslie Marshburn, a senior manager at global management consulting firm Kurt Salmon.
The idea behind reference pricing is simple enough; a payer or self-insured employer caps the amount it will pay for a given procedure, meaning patients who choose a provider that stays within the cap will only be responsible for their insurance plan's customary cost-sharing amount.
Reference pricing tends to lend itself to routine, non-urgent healthcare services. Listed below are the mean reference prices for six common services and procedures outlined in the article, based on 230 hospital referral regions.
1. Hip or knee replacement — $28,277
2. Colonoscopy — $1,463
3. MRI of the spine — $723
4. Echocardiogram — $433
5. CT scan of the head or brain — $297
6. Nuclear stress test of the heart — $171