Why does the same surgery cost $11,000 more on a Wednesday? Hospital price secrecy, explained.

Imagine sitting down in a restaurant and having every item on the menu listed as “market price” — and not being able to learn exactly how much anything costs until after you’ve placed your order.

For restaurateurs, that kind of business model would probably put someone out of business.

For healthcare providers, it’s not only the norm, but it’s also one of the primary reasons so many Americans struggle with medical costs.

Healthcare may be the only entity in which a service is rendered without the user of that service knowing what it will cost them. As a retired physician, I’ve seen how this lack of price transparency can take many forms — all of which are harmful and unfair to consumers.

Facility fees are a prime example of lack of transparency. These are added costs charged by hospitals for services provided there. This information is rarely conveyed to patients, and most patients are unaware of them.

In one specific case, a patient was asked if he wanted his arthroscopic surgery to be done on a Wednesday or a Friday.

The difference was not simply a difference in dates. It was also a difference in locations, as the Wednesday procedure would be done at the hospital, while the Friday procedure would be done at an outpatient surgery center.

The difference in cost was approximately $11,000 because of the facility fees at the hospital. If the patient had a 50% coinsurance policy, they would have had to pay more than $5,000 extra if they chose Wednesday over Friday. How many patients know to ask about this potential added expense?

Federal regulatory requirements have been in place since 2021 requiring hospitals to provide clear, accessible pricing information online about the items and services they provide, but compliance has been less than optimal — an analysis by one advocacy group found that fewer than a quarter of all hospitals fully adhered to the rule.

We must insist that these government mandates regarding price transparency be appropriately enforced. Furthermore, the ruling must be expanded to include any independent facility that provides any type of healthcare, such as a lab or imaging center. Patients have a right to know what things cost before they buy.

Facility fees must be removed to reduce the wide variability in costs at different types of facilities. Medicare has a policy in place to address neutral-site payments, but it only applies to certain services. This must be expanded to include all services and all insurers. Furthermore, this policy must be simplified and made readily available to patients in easy-to-understand language.

Hidden prices are also an issue in the pharmaceutical industry. The U.S. Department of Health and Human Services issued a ruling in 2019 requiring pharmaceutical companies to disclose costs in their direct-to-consumer ads.

Predictably, a lawsuit was filed by the pharmaceutical industry opposing this. The end result is that even today, pharmaceutical advertisements make only vague references to expected costs, and there are often multiple exclusions that make patients ineligible to get drugs at a reduced price.

One unique strategy to address some of the cost and transparency issues would be the increased use of direct primary care (DPC), which removes middlemen such as insurers and pharmacy benefit managers from the healthcare transaction.

Without middlemen taking their cut, patient costs come down. Patients who use DPC are able to get discounted posted rates on medications and testing, and they know in advance what their charges will be. Not surprisingly, the insurance lobby is opposed to this model because it restricts its control of the healthcare dollar.

Although affordability and price transparency are huge issues, we must keep in mind that there are many other variables that limit access to healthcare. Having insurance coverage does not eliminate long waits to see physicians or get imaging studies.

Delays can occur for a variety of reasons, such as physician shortages, administrative burdens, and increased patient demand. Efforts to address costs and clarity in prices unfortunately do not address these other issues.

Thus, as the midterms approach, we must consider all of the variables affecting access to healthcare. We repeatedly hear that healthcare is too expensive, but rarely do we hear anyone come up with any concrete strategies to lower healthcare costs.

Affordability is indeed a huge problem that must be addressed, but candidates must realize that access to healthcare is a much bigger issue. Addressing price transparency more strongly would be a good place to start any fixes.

Now all we need are legislators with the guts and determination to fight for patients against those who seek to exploit them for profit motives.

Mark Lopatin is a retired rheumatologist, a healthcare advocate, and the author of “Rheum for Improvement.” He speaks out regularly against forces that seek to compromise patient care in exchange for control of the healthcare dollar.