Hospital prices now available online

Feb. 02--Patients can now compare prices between hospitals, thanks to the recent implementation of a final rule by the Centers for Medicaid & Medicare Services.

The final rule relates to the fiscal year Inpatient Prospective Payment System and requires hospitals to post standard charges online in a machine-readable format for consumers.

"Price and quality transparency in health care is one of the top priorities for CMS and the Trump administration," said CMS Administrator Seema Verma in a recent press call. "If patients don't know the cost of care and compare costs across different providers, they cannot seek out the highest quality services at the lowest cost, as they do in any other industry."

A list of standard charges for hospitals in the Huntsville Hospital Health System -- which includes Athens-Limestone Hospital, Decatur-Morgan Hospital and Madison Hospital -- was made available earlier this month. However, in a statement from HHHS, the system emphasized the prices are a gross charge and not what the hospital receives or a patient might pay for a service, drug or supply.

"Our actual payments received for rendering these services are set by either the government or by negotiations with private insurance companies and are always less than the standard charges of caring for our patients," according to the release. "Payments we receive average about 20 cents for every dollar of gross charges we bill."

The charges vary, too, with seemingly basic services listed for one hospital but not another or appearing under different names. For example, Athens-Limestone Hospital lists "Control of Nasal Hemorrhage" for $278, Decatur-Morgan offers a similar entry of "Control Nasal Hem/Pack" for $185, and Huntsville Hospital has no similar entry.

The number of options also varies. On ALH's list, acetaminophen is listed once for $136. DMH also lists the drug once, for $96. Meanwhile, HH's list includes 18 mentions of the same drug, with prices varying from 60 cents to $337.50, depending on things like the dosage and method of administering the medication.

None of which are expected to be the price a patient pays to have a nosebleed dealt with or to receive a Tylenol for their headache. The HH Health System encourages patients to go beyond the list and speak to their insurance provider.

"Talk with their insurance provider to determine out-of-pocket responsibilities for meeting deductibles and any copayments due at the time of service. This will help clear up any misunderstandings that the posted gross charges may cause our patients."

If the patient doesn't have insurance, the HH Health System offers financial assistance programs for those who qualify. Assistance is also available for those using a machine that is not capable of reading the price list in the format provided by HH Health System.

Not enough

Verma called the move toward greater price transparency "a historic change" that "gives patients more information than they've ever had before about the services provided by their local hospitals." She also acknowledged the information is not patient-specific and called on hospitals to do more for their consumers.

"We have to do more," Verma said. "We have to not only increase transparency but also recognize that the solution is not as simple as just revealing prices. ... So let me be clear, hospitals don't have to wait for us to go further in helping their patients understand what care will cost."

As examples, Verma referred to the University of Utah's "See Your Out of Pocket Costs" tool that combines chargemaster prices with individual insurance information and UCHealth in Colorado's individualized estimates, available through a patient portal, mobile app and dedicated call center for price transparency.

"We look forward to more facilities exceeding our requirements as consumers demand great price transparency," Verma said.

As it stands, almost half of Americans say they may skip a doctor's visit when sick due to the impact of the cost on their budget. Forty percent have forgone routine preventative care altogether, Verma said, adding a similar percentage says they fear the financial costs of a serious illness more than the illness itself.

"Nearly 40 percent of insured Americans between the ages of 18 to 64 received some kind of unexpected medical bill after receiving the service," Verma said. "Even in Medicare, where beneficiaries have significant protections, we see patients surprised by their costs or in the dark when it comes to opportunities to save."

Moving forward

"From the moment I started at CMS, my focus has been on putting patients first," Verma said. "... Doing more of the same will not fix this problem, so we mus tmove our health care system on a different trajectory, one that points at what has always been its primary mission -- serving the interest of patients."

To that end, Verma said, CMS has proposed requiring pharmaceutical companies to disclose the list price of drugs in television ads and requiring each Medicare Part D plan to adopt a way for doctors to understand the cost patients will pay for their prescriptions.

The department has also sought input on how to define charges, what information would be most beneficial to patients and how best to enforce changes.

"While the work we have done to empower patients by increasing transparency is unprecedented," Verma said, "we are just getting started as we work to increase price and quality transparency throughout the entire health care system."

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