“Break a leg” is a common good luck charm said to many of New York City’s actors before a performance. But what if you actually broke your leg? In New York City, it turns out choosing an urgent care clinic (e.g., CityMD) followed by private practice care can be thousands of dollars cheaper than academic medical centers (e.g., NYU Langone, Mount Sinai).
This revelation was unlocked by recent Transparency in Coverage rules, which require health insurance companies to publish prices for every health provider across the US. As high-deductible health plans become more common and out-of-pocket costs soar, knowledge of healthcare price variability is more crucial than ever for consumers.
Certainly Health, in partnership with PayerPrice, analyzed terabytes of this price transparency data, revealing dramatic price variations between academic medical centers and combinations of urgent care and private practice follow-up care.
As a case study, we explore the cost of treating a hairline leg fracture - the injury behind the theatrical "break a leg" good luck wish.
Our findings are eye-opening: on average, broken leg care at academic medical centers costs 271% more than at urgent care centers combined with private practices. In one striking example, treatment through NYU Langone was 319% more expensive than a combination of CityMD, a private practice orthopedist, and a private practice physical therapist.
Case Study
For simplicity, we followed an actor with a hairline leg fracture that does not require surgery. For this episode of care, there are three stages from injury to recovery:
- Initial visit to urgent or emergency care
- Follow-up with orthopedist to receive a cast
- Going to physical therapy
We assume this actor has an Anthem BlueCross BlueShield $6,000 high deductible health plan, so he must pay the entire bill for all care up to $6,000 before his insurance contributes.
Urgent vs. Emergency Care
Let's break down the costs at each stage of treatment, starting with the initial evaluation by medical professionals after the injury. During the visit, the actor will receive a physician evaluation, X-rays on the broken leg, and a splint. We compared the difference in costs for these services at NYU Langone’s Emergency Department versus CityMD Urgent Care.
We also compared costs for a sample of academic medical centers to a sample of urgent care facilities, and we found that the average cost at academic medical centers is more than twice as expensive as urgent care centers. These price differences do not even account for the facility fees that emergency departments often charge for “walking in the front door,” which cost $713 on average in 2021.
Orthopedists
After the initial visit, this actor gets a referral to an orthopedic surgeon. We analyze the cost of removing the splint and applying a cast for an NYU Langone affiliated orthopedic surgeon compared to a Midtown private practice orthopedic surgeon. The price at NYU Langone is 378% higher than at this particular private practice office.
In general, a sample of academic medical center orthopedists had an average price 185% higher than a sample of private practice orthopedists across Manhattan.
Physical Therapy
Once the cast is removed, physical therapy is needed to regain strength, balance, endurance, and movement. One session of physical therapy at NYU Langone costs $217, whereas a private practice costs $51 per session. Assuming the patient needs physical therapy twice per week for two months, this 425% price difference compounds over time such that choosing the Midtown private practice could save the patient $2,656.
For a sample of academic medical centers, we found the average cost for two months of physical therapy was $2,156 more than the average cost for a sample of unaffiliated private practices. That’s a 332% difference.
The Bottom Line
From initial evaluation through physical therapy, the actor who has not met their $5,000 deductible will spend $3,670 more if he receives all his care through NYU Langone affiliated centers instead of a combination of CityMD and private practices.
On average, academic medical centers charge $2,888 (271%) more than urgent care and private practices for the same broken leg treatment.
Why are there such dramatic price differences? One NIH study highlights that market power is a key factor. NYU Langone and academic medical centers treat orders-of-magnitude more patients than any private practice, so they’re able to negotiate significantly higher reimbursement rates from insurers. Meanwhile, private practices have relatively low patient volume and less leverage to negotiate rates.
Do academic medical centers cost more because they have higher quality of care outcomes? An NIH literature review indicates that there is no association between cost and quality in US healthcare in general, and in outpatient settings, quality measurements are inapplicable for acute conditions such as broken leg care, and instead focus on preventative care and chronic conditions. It’s unclear whether higher prices correlate with higher quality of care, but it’s unlikely that the 4x price difference is worthwhile for less complex cases.
With new price transparency data, it’s gradually becoming possible for patients to make informed decisions that account for cost in choosing healthcare providers. So the next time you or someone you know needs medical care, remember that your decision on where to receive treatment could save you thousands. Breaking a leg doesn't have to mean breaking the bank.
If you live in NYC, you can enter your insurance and visit reason on Certainly Health to book health providers with guaranteed out-of-pocket costs. With Certainly Price Protection, if you owe more than the prices listed, we’ll cover the difference. Visit https://certainlyhealth.com/ to learn more and book without surprise bills.
