New price transparency requirements take effect for hospitals
January 8, 2019
STEAMBOAT SPRINGS — As of Jan. 1, hospitals nationwide are required to post a list of “charge” prices on thousands of procedures.
Making prices public makes it easier for patients to know the cost of services before they commit to them, according to the Center for Medicare and Medicaid Services, which implemented the new rule. It also allows individuals to shop for the best value.
Two other state transparency initiatives require all medical facilities to post self-pay prices for the top 50 inpatient procedures and top 25 outpatient procedures and for freestanding emergency centers to disclose certain information.
Colorado is under particular scrutiny for high health care costs, as an Oct. 4 Denver Post article reported a building spree, skyrocketing consumer prices and profits at nearly double the national average.
With Democrats in control of Colorado's Senate, House and Governor's office, more health care reform is anticipated in the coming year. Newly elected Colorado Gov. Jared Polis campaigned on a multitude of health care-related initiatives aimed at increasing transparency and lowering costs for patients.
"We want patients to have useful and accurate information that can help them make health care decisions," said Dan Weaver, senior director of public relations and communications with UCHealth, in response to the new federal requirements.
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However, “the prices posted do not represent what a patient would pay,” he emphasized. “The charge price is only the initial, nondiscounted price from which the discounts and the reimbursed amounts are based.”
They don’t include the self-pay discounts, discounts negotiated with insurance companies or any discounts, which most people get, Weaver explained. And they don’t take into consideration what hospitals are reimbursed.
Given the more obscure UCHealth spreadsheets, Weaver points consumers to their "UCHealth Patient Estimate Team" found on the same website, which provides consumers with real-time estimates online or over the phone by calling 877-349-8520.
UCHealth Yampa Valley Medical Center's charge master list can be downloaded by scrolling to the bottom of this page, clicking on “Hospital charge master files” and then “Yampa Valley Medical Center.”
At the Steamboat Emergency Center, Medical Director Dallas Bailes said they posted their numbers this week.
“We will be listing the prices for the 25 most common conditions treated on our website, and a list will be given to the patient after the patient receives a medical screening exam and an emergency medical condition has been excluded in compliance with the bill,” Bailes wrote in an email. “This list will have the charge master prices that are used in insurance negotiations as well as the self-pay prices for patients not using insurance.”
But while the top 25 or 50 procedure lists found on hospital websites, showing self-pay and uninsured prices as opposed to “charge” prices,” are easy to read, the new charge master lists can be a bit more cryptic to decipher, making searching for specific procedures and comparing to other hospitals a bit tricky.
The individualized estimates, Weaver said, take into account the specific patients and the details of their insurance plans, including where they are in terms of meeting their deductibles or out-of-pocket expenses. Estimates can be quoted with or without insurance and don't include fees of physicians not employed at UCHealth.
Three patients with the same insurance plan being treated at the same hospital could have different costs, Weaver said, depending on their deductibles, out-of-pocket maximums and co-payments.
Weaver said it is also valuable to see what hospitals are actually reimbursed by insurers and Medicaid and Medicare — information available at the Colorado All Payer Claims Database. The database also has an easy-to-navigate price-shopping tool, but the prices listed are dated 2016.
There can be a "big difference in actual charges and reimbursements," Weaver said.
According to The Denver Post article, “Hospitals in the state's western region charge insurers 35 percent more for inpatient surgeries than the average charged by hospitals in the Denver area, according to Anthem [Blue Cross and Blue Shield of Colorado] executives. The price difference insurers pay is even bigger for MRIs, which can cost as much as seven times more in Vail than what hospitals charge in the Denver area, found the state commission that studied health care costs. And those MRIs are prescribed at nearly seven times the rate in the mountain west than they are prescribed in Denver.”
But Weaver said Yampa Valley Medical Center prices are "close to average" and "very comparable" statewide, even on the Front Range. He pointed to MRI costs as being much more in line with the average.
During a Nov. 1 interview, Kevin Unger, president and CEO of UCHealth's Northern Colorado region, acknowledged as a "state and nation, we've got to get health care costs under control."
"Steamboat is well below the state average," he said in terms of costs at the local hospital.
He also pointed out the quality of care is among the best in the state, with high patient satisfaction scores.
Weaver called YVMC “very competitive” in terms of prices across the state.
According to Soniya Fidler, the hospital’s chief operating officer and interim president, Yampa Valley Medical Center also has been able to decrease costs, including CT scans by 20 percent, GIs by 16 percent and MRIs by 40 to 50 percent.
The new charge master lists of procedures for hospitals are extensive – ranging from 246 pages for Yampa Valley Medical Center to 2,368 pages for Denver Health. Some are easier to locate than others on the main website.
And while detailed, they are not user friendly in terms of easily locating a specific procedure or understanding the coded language or any apparent organizational system. The formats vary greatly from hospital to hospital.
Many items have a wide range of costs and would require more information to fully understand what costs a patient might be facing, especially with their individual discounts.
A pacemaker at Yampa Valley Medical Center ranges from $19,000 to $41,000. Treatment of a respiratory infection ranges from $14,000 to $34,000. While some things, like Ibuprofen, have eight different prices listed depending on dosage — ranging from five cents to $2.66 — other items encompass broader categories and are much less straightforward, such as “Major hip and knee joint replacement or reattachment of lower extremity w MCC or total ankle replacement.”
Depending on level, the cost of sutures range from $10 to $644. But a “suture kit” is listed at $2,626.50. Does that mean a suture kit is always part of the cost?
Regardless of the configuration of the information, more data is now publicly available. But help translating much of it is still required to genuinely know ahead of time what a hospital bill might look like.