We’re still in the dark about hospital and medical treatment prices
25th April 2022 · 0 Comments
Costs associated with hospital services strike fear in the hearts of many prospective patients. Are the procedures and treatments affordable? Will a payment plan or loan be necessary?
Anyone who needs a C-Section, gallbladder removal, hip replacement, endoscopy, or other standard hospital procedure knows the bill will be incredibly high. But just how much the final bill will be is anyone’s guess.
The Centers for Medicare and Medicaid Services (CMS)’s hospital pricing transparency rules took effect a year ago. However, without advanced knowledge, Americans are still in the dark about how much medical procedures cost, how much out-of-pocket money they’ll pay, and how much their medical insurance will cover.
Reports are that 85 percent of hospitals across the U.S. are non-compliant.
Under the pricing transparency rules, hospitals must post prices in an accessible manner, using precise language. The truth is that hospitals have found ways to skirt the requirements by not complying or if and when they do, the price estimates vary so much that the primary idea of allowing consumers to comparison shop for the best prices is a pipe dream.
According to a locally generated report, “Hospital Price Transparency & Its Implementation in Arkansas, Louisiana and Texas,” published in Social Policy magazine, Louisianans are in the dark about hospital prices for standard procedures. The findings are enough to make you sick.
Researchers at ACORN International, Labor Neighbor Training and Research Center, and United Labor Unions Local 100 found that “the American patient is nowhere closer to being able to guess the ultimate costs of their healthcare” a year after the policy went into effect.
David Thompson, the report’s lead researcher, said published charges at all hospitals in Arkansas, Louisiana, and Texas brought his team to conclude that less than half of the hospitals surveyed have truly accessible pricing transparency tools.
However, accessing the prices doesn’t help prospective patients because charges for procedures vary widely.
“Why does one New Orleans hospital set the charge for a c-section at $39,230 while another sets it at $2,141? We may never know, but what we do know is that price transparency doesn’t lead to price rationality,” Tompson wrote in an opinion piece.
The team of researchers also found hospitals are using complex coding systems, listing varied prices for procedures that look to be identical, or breaking down procedures into arbitrary component parts. This makes direct comparisons of costs virtually impossible for individual consumers.
Researchers found that price comparison tools were only truly accessible at 33 percent of Arkansas hospitals, 42 percent of Louisiana’s, and 30 percent of Texas’. Of the minority with accessible tools, the estimates were often useless.
When an “estimate” for an operation can range between $9,000 and $200,000 at one hospital, how is a patient supposed to be able to make an informed choice? Thompson said of a procedure at Highland Hospital in Shreveport, Louisiana.
The report’s New Orleans Snapshot shows 48 percent of hospitals have accessible comparison pricing tools: Ochsner Medical Center Kenner LLC, Slidell Memorial Hospital, Ochsner Saint Bernard Parish Hospital, Saint James Parish Hospital, Tulane Medical Center, United Medical HealthWest New Orleans, University Medical Center New Orleans, West Jefferson Medical Center, Saint Tammany Parish Hospital, Ochsner St. Charles Parish, and Jennings American Legion Hospital.
Among the facilities that have unreliable or unavailable tools include Ochsner Medical Center Jefferson Highway, River Oaks Hospital, Our Lady of the Lake Southern Surgical Hospital, Saint Charles Surgical Hospital, and Ochsner North Shore Extended Care. Also, Avala Hospital has a difficult-to-access comparison tool due to a complicated excel spreadsheet.
Hospital pricing transparency rules – Surprise. Surprise, Surprise – were initiated by the Trump administration in 2019. It turns out, though, that while the policy could be of great benefit to healthcare consumers, there were no real consequences for non-compliant hospitals.
What’s more, the CMS set the policy’s effective date two years from the date of Trump’s executive order. Huh? It seems like the policy was put in place as fodder for Trump’s presidential campaign.
The Biden administration comes, and Chiquita Brooks-LaSure makes history as the first Black woman to lead the CMS. The medical policy expert worked on the Affordable Care Act (ACA) and Capitol Hill before being confirmed by a bi-partisan Senate. Brooks-LaSure says her main priority is achieving health equity for all Americans.
Brooks-LaSure amped up the hospital pricing transparency rules and added stiff penalties for non-compliant hospitals, but here we are in 2022, and 85 percent of hospitals are non-compliant. LaSure has sent out 300 warning letters to hospitals, but none has been fined.
Americans also have concerns about not knowing how much they’ll pay if procedures are done by out-of-network providers. Bu “Surprise Billing” is a different story for another day. Biden’s CMS issued a policy against Surprise Billing when it announced its hospital pricing transparency requirements.
“In 2019, CMS Administrator Seema Verma said that ‘under the status quo, healthcare prices are about as clear as mud to patients.’ Today, the light might be shining on that mud, but it’s still a mess. And it will stay that way until hospitals start doing better, or the government starts making them,” Thompson concluded.
Unless the CMS takes direct action and begins fining rule skirters, the hospital pricing transparency tool mandate is no more than a paper tiger.
So much for transparency and health equity. And political rules. We know the wheels of justice turn slowly. But we won’t hold our breaths.
As usual, we, the people, must be proactive. It’s our right to know the cost of health care procedures in advance. We must demand to know the total costs of any hospital procedures before getting them. If hospitals refuse to provide this information, call the CMS and make a formal complaint. Meanwhile, shop around, and compare prices. Hospitals that have accessible pricing tools may be our best bet to at least get an estimate, albeit wide enough to drive a truck through.
This article originally published in the April 25, 2022 print edition of The Louisiana Weekly newspaper.
