American consumers are encouraged to shop for health care but have little ability to do so effectively, and a new federal requirement isn’t expected to do much to change that.
Starting Jan. 1, hospitals had to post their list prices online. But the data is difficult to interpret and bears no direct correlation to what most consumers will be expected to pay.
Nevertheless, U.S. Health & Human Services Secretary Alex Azar characterized the posting and other changes as important steps toward putting patients in charge of their care and allowing them “to receive the quality and price information needed to drive competition and increase value.”
The list prices, also called chargemaster rates or sticker prices, are much higher than what patients are typically charged, because they don’t factor in health insurance or other discounts.
They’re also not user-friendly, with the lists of thousands including entries like “HC NEU SOF LVL 25 IMP HARDWARE” and “ELBOW COMP MIN 3V - LT.”
And as the nonprofit Kaiser Health News reported, “To figure out what, for example, a trip to the emergency room might cost, a patient would have to locate and piece together the price for each component of their visit — the particular blood tests, the particular medicines dispensed, the facility fee and the physician’s charge, and more.”
Dan Angel, vice president of revenue cycle at Penn State Health, which operates Hershey Medical Center, said the requirement is a step in the right direction, but summarized widespread concern across the industry.
“We feel that posting the charges really is not very useful to the health care consumer, and in some cases it can actually be confusing,” he said.
Hospital representatives say a better option is to call their institutions.
Each system has an office set up to provide estimates of how much a procedure might cost a given consumer, after factoring in health insurance or other discounts.
Lancaster General Health reported fielding about 200 calls a month from people seeking cost information.
It also reported making about twice that many calls to patients — five to seven days before a scheduled procedure — who were expected to incur out-of-pocket costs, to make sure they knew what to expect and to offer financial counseling.
Lancaster General Health also has an online price estimator for common procedures, and it asks for insurance information.
Angel said Penn State Health is working to launch an online estimator in the coming months.
And, he said, in addition to providing estimates, the system’s financial counselors can help with other concerns, like helping uninsured patients get financial assistance or charity care.
All five local hospitals — including WellSpan Ephrata Community Hospital and UPMC Pinnacle Lancaster and Lititz — offer medically necessary care free to qualifying patients with family income below a certain percentage (200 to 300 percent, depending on hospital) of the federal poverty level.
Health insurers are another option for consumers seeking price information; many have some form of estimator designed to help members compare expected charges from different providers.
But, as Angel noted, deciding where to go for medical care isn’t just about price.
“There’s quality of care that the institution provides, location — charges obviously are just one piece,” he said.
There are several widely used hospital rankings, each calibrated differently. They include Medicare’s Hospital Compare site; U.S. News & World Report’s Best Hospitals list; and the Leapfrog Hospital Safety Grade.
Additionally, the independent state agency Pennsylvania Health Care Cost Containment Council issues many public reports a year on health care facilities and procedures.
HAP’s Andy Carter: The @CMSGov mandate & discussion it will likely engender may foster a better understanding of what useful #price #transparency might look like—if policymakers, media & consumers can agree on realities of how America pays for its care. https://t.co/1518CbDVdr pic.twitter.com/iz3olnboTs— HAP (@HAPupdates) January 7, 2019
Said hospital is in Ohio, not #LancasterCounty, and per story has bundled prices for more than 300 services "driven by the #Amish community's desire to shop for the best deal and pay in cash at the time of service." #healthcare https://t.co/oCjMsdjfxN— Heather Stauffer (@HStaufferLNP) January 9, 2019