Let's not fool ourselves. Consumer-directed health care is all about us, as individual consumers, paying a bigger share of our medical bills.

		Eileen Anderson is designer at Red Clay Tile Works, based in Bellevue (redclay@city-net.com). She is a member of the SMC Business Councils and serves on its Government Relations Committee. She was on the board of directors of Suburban General Hospital from 1996 to 2004.

According to the policy experts' theories, if we consumers spend our own money, we will become cautious, even stingy, about our use of health care. These geniuses believe that a nation of health care bargain-hunters will bring runaway health care costs under control.

I wonder if any of these policy wonks have tried to practice what they're preaching -- to try to shop for health care on the basis of price and quality?

Maybe your idea of fun is putting together a 1,000-piece jigsaw puzzle of a snowy scene. Health care is that complicated. Now imagine trying to put together the puzzle in the dark. Shopping for health care is like that -- groping vainly in the dark for any usable information about prices or quality before you buy.

If you need to shop for even a routine health care service, consider taking a couple of vacation days so you can stay with the phone calling, being put on hold, having your calls transferred repeatedly and waiting for return calls.

My physician recommends an annual screening mammogram, so that has become my first experiment with health-care shopping. I ended up calling 10 potential providers within striking distance of my home. The first lesson learned was that it is essential to know the Current Procedural Technology code, or CPT, of the medical procedure in order to do useful comparison shopping. Most hospital billing departments can't or won't talk about pricing without this code. (The CPT code for a mammogram is 76092.)

My initial phone contact was usually a customer service person that transferred me to billing, women's health or radiology. There I might get a human or a voicemail. If it was the right department, and I was having a really good day, I would be put on hold for several minutes, and someone would eventually tell me some part of the price for a mammogram. Sometimes there would be a promise of a return call -- usually, but not always, within a day or two. In other cases, I would be transferred back to the receptionist and be forced to start over.

	Anita Dufalla, Post-Gazette Click illustration for larger version.

One of the tricky things about shopping for a mammogram is that there isn't just one bill. There is a hospital bill for the actual test, and a physician's bill for reading the test. Hospitals quoted their price only, but in some cases offered an estimate of the physician's bill. To determine the actual physician charges would have meant an additional round of phone calls. Instead, I "guesstimated" a $50 reading fee for a traditional mammogram.

A second unexpected hurdle was learning that there are three different kinds of mammograms. The highest quality image is produced by new, more expensive, digital technology. Traditional (analog) mammograms are based on film technology. In between digital and analog is analog with a computer-scanned and -read film. I learned a lot more than I ever wanted to know about these types of mammograms, including the wide variation in false positives/negatives.

Mammogram prices, as you might guess, were all over the place. Furthermore, the prices quoted by hospital billing departments are always retail prices, but insurers negotiate deep discounts for their subscribers. Only those who don't have health insurance are charged full retail. (Go figure: Those who cannot afford insurance must pay the highest price.)

In a rational world, an insured consumer would be able to find out the discount price for a service in advance. This vital information, however, is almost impossible to discover due to a high-voltage fence of public laws and hospital-insurer contracts intended to prevent consumers from finding out discounted prices -- until after a health-care service has been delivered. (What business owner wouldn't love to do business this way -- with blindfolded customers!) I persisted and eventually learned that my insurer's discounted price for a mammogram was about 50 percent of the retail price quoted by a hospital billing department.

Among non-profit hospitals, the highest price quoted for a mammogram was at Allegheny General -- $400 plus a $111 reading fee. AGH, however, was the only hospital on my list that used the most advanced highest quality (and most expensive) digital image technology. All other providers used analog technology.

The lowest hospital price I was offered for an analog mammogram was at Mercy Hospital -- $89.10. Magee-Womens Hospital quoted $220. UPMC Shadyside cited a price of $338 for a diagnostic mammogram. UPMC Passavant charged $248.25. Two hospitals that stood out among the others because they gave prices reasonably quickly were Sewickley Valley Hospital at $224 and Allegheny General-Suburban campus at $200. (I eventually gave up on wrangling a quote out of an eighth hospital.) For comparison purposes, I assumed an additional $50 physician reading fee.

In addition to the above non-profit hospitals, I also called two for-profit vendors: Weinstein Imaging and Women's Imaging North. Weinstein Imaging quoted me $104 for a mammogram, reading fee included -- the lowest total price of all providers. Women's Imaging North offered a price of $150, but for an extra $50 one could add a computer scan of the analog film in addition to the radiologist's reading of the film.

After I waded through all of the numbers, I came to the typical shopper's questions about quality and value. I am not a doctor or a scientist, but the receptionist (!) at Women's Imaging North told me that almost all customers opted for the extra computer scan in order to assure accurate reading. I decided to forgo the lowest price (Weinstein) and get my mammogram at WIN. Because I have high-deductible health insurance, I will pay $200, minus the discount negotiated by my insurer. My out-of-pocket cost for this year's mammogram will be about 20 percent less than last year's screening (done at a local hospital).

Some concluding thoughts: The for-profit vendors had much better customer service than the hospitals. Hospital personnel were always courteous and wanted to be helpful, but rarely were they totally comfortable with quoting prices. Approximate prices were eventually accessible, but the cost/time/patience equation is problematic.

My overriding impression is that no one who helped to create the health-care system -- providers, insurers, administrators, politicians -- has used the system as a self-paying customer and gone through the experience of shopping for any health-care service.

A mammogram is a common, comparatively simple medical service, but my ordeal shows that the health-care industry is a long, long way from being able to meet its customers' needs in the brave new world of consumer-directed health care.