As consumer-driven health-care and health savings accounts become more popular, it will soon be possible for Iowans to go online to compare prices on procedures ranging from hip replacements to heart bypass surgery.

Early next month, Wellmark Blue Cross and Blue Shield plans to launch its Treatment Cost Estimator, an online system that will enable participants in its plans to look up estimated costs for approximately 600 medical procedures.

The Iowa Hospital Association is also within weeks of rolling out a statewide price-comparison system that will involve all of the state’s hospitals.

Those two initiatives come on the heels of a procedure-pricing system introduced last month by Mercy Medical Center – Des Moines on its Web site, which appears to be one of the first such systems to go online in the state.

“We are trying to be responsive to what we believe is a desire by customers for more information about hospital pricing practices,” said Steve Kukla, Mercy’s chief financial officer. “I think that as consumers are becoming more responsible, both in terms of [managing health-care expenses] and also in managing their own health status, I think we’re going to see a desire for more information about what treatments are available, and what the costs will be.”

Under the current health-care system, consumers with health insurance typically have no idea of the actual costs of medical care because they either make a small co-payment for doctor visits and prescription drugs, or incur a fixed out-of-pocket fee for major procedures, after which the insurer pays the remainder. Those without health insurance often qualify for programs for reduced or waived fees.

With the move toward consumer-driven health-care options in which people are moving toward high-deductible health plans coupled with health savings accounts, being able to compare costs will become more important. Finding a user-friendly way to provide the information, though, has proved difficult.

However, many states and the federal government are demanding it. According to the American Hospital Association, 32 states already require hospitals to provide pricing information, and hospitals in six other states have voluntarily made that information available.

At the federal level, President Bush signed an executive order in August requiring the U.S. Department of Health and Human Services to make cost and quality data available to all Americans. The department currently posts national average costs for the 30 most common elective inpatient hospital procedures on its Web site. Additionally, a bill introduced in Congress earlier this year would mandate hospitals to post pricing information online.

“With the press for high-deductible health plans and health savings accounts, consumers are pushing for more information,” said Scott McIntyre, a spokesman for the Iowa Hospital Association. “And really, the Internet provides the ability to do that. Without the Internet, it would be really difficult to make a system like this work and keep it updated.”

McIntyre said he believes efforts by hospitals in Iowa and other states will preclude any need for a national mandate to be passed by Congress.

Iowa Health-Des Moines, which operates Iowa Methodist Medical Center, Iowa Lutheran Hospital and Blank Children’s Hospital, said it plans to provide online pricing information using the hospital association’s system, rather than creating its own system.

Joe Corfits, Iowa Health’s chief financial officer, said he doesn’t know yet how user-friendly the system will be because it hasn’t been demonstrated to the hospitals yet.

Providing the hospital charges is “a first step,” Corfits said. “I think in order to give to the consumer the information they’re ultimately looking for — what I have to pay — a lot more work has to be done to collaborate with the insurance industry.”

The patient-discharge data that the prices will be based upon is already reported by every Iowa hospital to the hospital association, so the project doesn’t represent any extra work for the hospitals, Corfits said. “It actually saves us some work, because we don’t have to replicate efforts on our own Web site,” he said.

Each of Iowa’s hospitals has been “very supportive” in providing information for the statewide database, said McIntyre, who declined to provide specifics about the system prior to its January rollout. “Our movement has been based on the direction of our board, which is made up of hospital people, so we’re definitely in line with what the hospitals want to do,” he said. “And we do represent all the hospitals in the state; they are all members of the association.”

The movement toward greater price transparency is not limited to hospitals. One of the state’s largest physician groups, the Iowa Clinic, is in the beginning phases of determining how it might implement an online system.

“It is something we would like to do,” said Ed Brown, chief executive officer of the Iowa Clinic P.C. “We are looking at what’s been done [by clinic groups] in Wisconsin and the state of Washington.”

Among the hurdles, Brown said, is determining how to publish competitive pricing information in a way that won’t run afoul of antitrust laws.

“Obviously, we have different pricing for different payers,” he said. “And we also have competitors in the marketplace. If we just publish that openly on the Internet, other physician groups can look at that and say, ‘We want to be paid that as well.'”

Brown said the clinic also needs to decide whether such a system would be built in-house or outsourced to a third-party company.

“We would hope we could begin having those discussions with our group within the next quarter,” he said.

As such online pricing systems are rolled out, medical experts point out that the choice of a primary-care physician remains a key health-care shopping decision. Typically, those doctors direct care for patients with the most severe conditions, which don’t lend themselves to price-shopping.

Some specialty groups, such as Iowa Heart Center, say they don’t plan to provide online price information, in part because of the nature of the procedures they provide.

“The prices only mean something to us,” said Rob Schweers, an Iowa Heart spokesman. “The insurance or Medicare reimbursement really determines what we get paid. The vast majority of our patients have insurance. For those who don’t, if they’re at 200 percent or less of poverty level, we write off the bill.

“Also, we do very little that’s elective,” Schweers said. “Elective, in our world, means you can have it now or have it on Monday, you choose.”

Wellmark spokeswoman Angela Feig said her company’s system will likely be the most accurate pricing resource for Wellmark members.

“It’s very, very comprehensive,” Feig said. “It’s based on one of the largest databases from the Blues plans nationwide. It has 600 episode treatment groups, or major categories of care. So if you were going in for any kind of procedure, it includes all the services that would be part of that treatment. So it’s the total treatment cost that’s estimated, not just the hospital portion.”

The system will be particularly useful to those who have high-deductible health plans coupled with a health savings account or those estimating their flexible spending plan for the coming year, Feig said. But it will also be a valuable educational tool to make those with traditional coverage more aware of the actual costs of procedures, she said.

“I think it will be equally beneficial for both, because that kind of information has always been a mystery,” she said. “It’s putting more information in the hands of the consumer.”