Social media points people to theWearTheCost.org website, which shows huge differences in what thesame procedures cost at different Maryland hospitals. (CaitlinHillyard/KHN illustration; Getty Images)

If only patients knew how expensive medical procedures are and howwildly prices vary by hospital, they could besmart shoppers and lower the cost of health care for everybody.

At least that's what policy experts and health insurers keepsaying as they promote “consumer-directed” health care and cost-comparison websites.

Related: Health plans don't give consumers pricetransparency

None of it has had much effect. Now, exasperated Maryland officials are presentinghospital cost information in a way they believe Americans mightunderstand: on a T-shirt.

“We tried to focus it on a level most consumers are at,” saidBen Steffen, executive director of the Maryland Health CareCommission, which created the campaign. “It is an opportunity towear a billboard in certain public settings” to get people to askquestions, he said.

You can get a blackshirt that says “HIP REPLACEMENT $30,067” in big type from thecommission's WearTheCost.orgwebsite. Or one that says “HYSTERECTOMY $16,138.” Other shirtsfeature prices for a knee replacement or baby delivery.

“I sent an email to all my colleagues in the health-policy wonkworld and said, 'I just got your holiday gift,'” said Dr. AteevMehrotra, a Harvard Medical School professor who has studiedmedical price transparency and patient responses.

Social media for the campaign points people to the WearTheCost.org website, whichshows huge differences in what the same procedures cost atdifferent Maryland hospitals.

The hysterectomy expense of $16,138 on the T-shirt is just anaverage. In recent years, the operation cost as much as $20,635 atJohns Hopkins Hospital in Baltimore and as little as $12,798 atAnne Arundel Medical Center in Annapolis.

Hopkins was also the most expensive hospital in which to have ababy, at $14,578, compared with the average Maryland cost of$11,590.

“Our teams treat the most complex cases in the region,” makingthem more expensive, said Hopkins spokesman Ken Willis. Hopkinssupports publishing data to help patients make informed decisions,he added, but he said the Wear the Cost site “does not yet achievethat goal.”

The website's price quotes apply to commercial insurance ratesand include hospital care as well as non-hospital spending, such asdoctors' fees and prescription drugs.

The reported expenses are adjusted so that “it would takeaccount of differences in case severity,” Steffen said.

Hospital-to-hospital results vary sharply even under Maryland'shealth care finance system, which regulates what hospitals arepaid. One reason is that hospitals make money from their mistakes.Those with high rates of avoidable complications, such asinfections or drug reactions, end up delivering more care, forwhich they charge.

Wear the Cost's software tries to measure this, flaggingavoidable problems and calculating the expense. Potentiallyavoidable complications added $2,271 to the cost of a hysterectomyat Johns Hopkins.

Such costs were even higher at Baltimore's Saint Agnes Hospital,adding $5,481 to a hysterectomy's total cost of $18,433. (Thehospital did not respond to requests for comment.)

A $4 million federal grant financed the Wear the Cost campaign,which was led by the commission's analysis director, LindaBartnyska, who died of breast cancer in August.

Economists like to note that health care lacks many attributesneeded for a minimally functioning market, including customers whounderstand the product and know what it costs.

The price transparency movement was supposed to help fix that.If patients give more business to lower-cost institutions withfewer complications, the thinking goes, hospitals will work harderto contain costs and improve outcomes, slowing the increase ininsurance premiums and government health expenses.

“The hope is that, over time, consumers will come to expect thatprices are available … and use them regularly in making decisionsabout where to get care,” said Sarah Litton of Altarum, a researchand consulting firm that worked on the campaign with the Marylandcommission.

But it's an uphill fight. Nobody checks hospital prices whenthey have a heart attack or get in a car crash, so Wear the Cost,which has given away more T-shirts than it has sold, focuses onelective procedures that people can shop for in advance. Even thesepatients, though, tend to go to wherever doctors suggest. Sinceinsurance usually pays everything for in-network hospitals onceout-of-pocket spending limits are met, they have little incentiveto shop around when considering pricey procedures. The patient'sportion is likely to be similar whether a joint replacement is$25,000 or $50,000.

Federal authorities recently required hospitals to start posting their chargesonline, but these bear little relationship to what most patientsand their insurers pay.

Just 3 percent of adults under age 65 compared costs betweenmedical providers before getting care, found a 2017 survey led byMehrotra.

“To date, price transparency initiatives that have beenrigorously assessed have had little to no impact on prices in thehealth care system,” Mehrotra said. “The reason so far is fewpeople are using those websites.”

Still, maybe the point of programs like Wear the Cost “is toshame” expensive hospitals, to say, 'What the heck is going onhere?'” Mehrotra said. “'Why are you 50 percent more'” than thehospital across town?

Kaiser Health News is anonprofit news service covering health issues. It is an editoriallyindependent program of the Kaiser Family Foundation, which is notaffiliated with Kaiser Permanente.

Read more about pricetransparency:

• Consumers using price transparency to budget, notcomparison shop
• The next frontier in price transparency: Bettertools
• How to improve transparency and take control overhealth care costs