NTMC misses deadline to post price list

Feb. 02--North Texas Medical Center in Gainesville appears to have missed a Jan. 1 deadline to comply with new price transparency requirements issued by the federal Centers for Medicare and Medicaid Services, a review of the hospital's website indicates.

The Centers for Medicare and Medicaid Services, or CMS for short, announced new guidelines in August 2018 requiring hospitals to post a spreadsheet of their standard charges to their websites. The agency announced it was an effort to give patients a way to better compare services from different hospitals, though critics have noted that hospitals' standard charges lists are often filled with jargon and don't reflect the prices paid by insurers or Medicare/Medicaid.

Previously, the agency explained in a press release, a hospital could post any form of price list or its pricing policy on its website to comply with CMS guidelines.

"While CMS previously required hospitals to make publicly available a list of their standard charges or their policies for allowing the public to view this list upon request, CMS has updated its guidelines to specifically require hospitals to post this information on the internet in a machine-readable format," according to the CMS press release issued Aug. 2, 2018.

The pricing transparency page on NTMC's website, when the Register accessed it as late as Friday morning, Feb. 1, included only the hospital's pricing policy and instructions for getting a price list from its patient financial services department.

CMS's updated guidelines require price lists to be posted online in a "machine-readable" format, like XML or CSV spreadsheet filetypes. A PDF won't do, the agency clarified in a FAQ, because it's not easily imported into a computer system.

A hospital spokeswoman referenced what appeared to be CMS's former guidelines issued in 2014 when asked why a price list wasn't posted to its website.

"In August 2018, CMS finalized a rule requiring hospitals to publish a list of their standard charges online," spokeswoman Kristi Rigsby wrote in a statement emailed Friday, Feb. 1. "A hospital is 'required to either make public a list of their standard charges or their policies for allowing the public to view a list of those charges in response to an inquiry.'"

Rigsby said Friday that hospital staff "are obviously aware of the mandated regulation and are confident that the information we have had available via our website since Jan. 1 met those requirements." She added the hospital had contacted CMS to confirm that its posting met the requirements and expected to hear back on Monday.

She noted that NTMC provides its standard prices upon request and lists how to request it in the policy on its website.

"Healthcare pricing can be confusing," she wrote via email. "That's why we provide a knowledgeable hospital employee who is available to discuss an individual's situation, because standard pricing does not take into account insurance coverage or our financial assistance program."

Critiques of the new rule have also focused on the confusion that can arise from the standard charge lists hospitals are now required to publicize.

"This policy is a tiny step forward, but falls far short of what's needed," Jeanne Pinder, the founder and chief executive of Clear Health Costs, told The New York Times in January. "The posted prices are fanciful, inflated, difficult to decode and inconsistent, so it's hard to see how an average person would find them useful."

Clear Health Costs is an independent medical price transparency website funded through grants.

It's unclear what, if anything, might happen to NTMC as a result of the missed deadline. An additional FAQ published by CMS indicated failing to publish standard hospital pricing on the internet means a hospital isn't in compliance, but "specific additional future enforcement or other actions that we may take with the guidelines will be addressed in future rulemaking," the CMS FAQ read.

Cooke County's only other hospital, Muenster Memorial Hospital, has posted its price lists in both CSV format and as a PDF. They're found via a link on its homepage called "Chargemaster," a common term for hospitals' standard pricing mechanisms.

MMH spokeswoman Gayla Blanton said the hospital made those lists available online Dec. 21, 2018.

"We have not received any public feedback," Blanton said by email this week. "We are of the opinion that although the thought behind the posting -- transparency -- is good, the price listing creates more confusion for consumers, as no hospitals charge the same and all hospitals are paid at different rates. This is explained in the information published with the price list."

The explanation on MMH's website compares its standard rates to the manufacturer's suggested retail price of a car. The hospital notes that government insurance plans like Medicare and Medicaid have their own set rates that hospitals are required to accept. Insurers also negotiate their own prices with providers. The hospital encourages patients without insurance to "contact the hospital before a procedure to discuss charges, alternative pricing and payment terms."

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