Price Tag on Health: Push for pricing transparency bewilders patients

By Jill Nolin – Valdosta Daily Times

Photo courtesy of Valdosta Daily Times.

ATLANTA – Hospitals must now publicly post their prices for delivering a baby, doing a brain scan and any other of the thousands of services they provide.

This added transparency, now required under a new federal mandate, is meant to demystify hospital prices for consumers and encourage competition among providers. In theory, the move is designed to drive down health-care prices.

But in practice, having more information available hasn’t exactly equated to more clarity, as consumers go online to find streams of codes and mostly cryptic descriptions of medical tests, procedures and equipment with prices that, in the end, likely do not reflect what they will have to pay.

The items range from the vague – such as the “respiratory signs and symptoms MS” for more than $11,000 at South Georgia Medical Center in Valdosta – to indecipherable jumbles of letters, such as “CL TX IP JOINT DISL; WO A” for $296 at Colquitt Regional Medical Center in Moultrie.

Sterile supplies used during a visit at Hamilton Medical Center in Dalton might set a patient back just $5 – or it might cost them $12,813.

The spreadsheets can also be unwieldy documents. The Tift Regional Medical Center list, for example, weighs in at 75,540 words, leaving it just 1,400 words shy of the first Harry Potter book.

‘Bewildering gobbledygook’

Hospitals maintain a list of prices – known as a “chargemaster” – offering a rundown of the wide variety of the services they offer. It’s this list that hospitals have put online in response to a Trump administration mandate that took effect last month.

But the trouble with the lists isn’t just limited to how difficult they are to translate.

The prices listed are unlikely to represent what a patient is actually charged, since insurers often negotiate deep discounts. Beyond that, it’s unlikely someone would be able to accurately piece together the various services that make up a single visit, and the lists may also not be comparable from hospital to hospital.

Some of the price lists for hospitals in the SunLight Project area, which includes Valdosta, Thomasville, Tifton, Moultrie, Milledgeville and Dalton, were easy to find on the hospital websites. Others required a little hunting.

“These spreadsheets are hard for ordinary people to find,” said Jeanne Pinder, chief executive officer and founder of Clear Health Costs, a consumer research organization that provides location-specific cost information. “They’re written in a bewildering gobbledygook of medical shorthand – so even if you can find them, they’re hard to understand.”

And if consumers do find what they are looking for on the list, the price is likely to be the inflated “sticker price,” Pinder said.

“Hospitals don’t like to talk about these inflated prices, and they dismiss them with ‘Nobody pays that anyway,’” she said. “That’s true, but the hospitals could do a lot more to clarify pricing — but they don’t want to. And the federal government, or the states, could do a lot more to clarify pricing — but they don’t.”

Still, William Custer, a professor at Georgia State University who studies health-care financing, said the requirement is a step toward transparency. Custer noted, for one, that the list could be a useful tool for employers and insurers who regularly haggle with the hospitals for discounted prices.

“More people know more now than they did before,” Custer said. “But it’s certainly not to the point where a consumer can use that chargemaster and evaluate exactly how much it’s going to cost them at hospital A versus at hospital B.

“This is an important step, but it’s an intermediate step toward providing useful information to the consumer,” he said.

Someone who is uninsured, or who needs to see an out-of-network provider, might find that the prices are closer to what they are billed, said Berneta Haynes, who is the director of policy and access at Georgia Watch, a consumer advocacy organization.

But most consumers, she said, are better off looking elsewhere for guidance on cost.

“Set that aside. It’s not going to be helpful for you,” Haynes said of the hospital price lists, dismissing the new federal requirement as “political theater.”

“It’s really just legislators patting themselves on the back instead of going the extra mile and doing what needs to be done to nip in the bud surprise medical bills and high insurance costs,” she said.

Haynes said she encourages consumers to consult Georgia Watch’s guides or websites – such as Fair Health Consumer or Healthcare Bluebook – that compare prices for services based on geographic location.

SunLight Project hospitals

Several hospital administrators in the SunLight Project coverage areas acknowledged that studying the price list is not the best way for their patients to gauge their costs.

“While I commend (the federal government’s) effort to promote price transparency and help patients understand the cost of health care, I do not believe this step will improve the patient’s understanding of health-care costs,” said Kim Willis, Tift Regional’s chief financial officer.

“To provide a patient with true price transparency, we offer a personalized estimate of a patient’s out-of-pocket costs based on the services provided and the patient’s specific health plan,” she said.

And since no two patients are alike, there will be variables that are not reflected in the price list, said Johnny Ball, assistant administrator of communications and public affairs at SGMC.

Factors such as a patient’s age and whether they have multiple diseases can complicate the service provided, affecting the cost.

“Because chargemaster prices are not all inclusive, it is like buying a car,” Ball said. “There is the sticker price for the base model, then the price with the various options added in.

“Savvy patients should call their physicians and insurance carriers when trying to determine benefits,” Ball said. “Chargemasters do not take negotiated insurance discounts, co-pays, co-insurance and deductibles into account.”

In Dalton, Hamilton Medical Center, like other hospitals, directs patients to call a phone number for helping figuring out their costs.

“A hospital’s chargemaster can be very confusing and may not accurately reflect a true estimate of hospital charges,” said Joe McGuire, the hospital’s chief financial officer. “The listed amounts do not include insurance contract discounts and other adjustments, nor would the figures reflect actual out-of-pocket costs that a patient would pay.”

Lynne Byrd, who is the vice president of Archbold revenue cycle operations, said a patient’s actual costs can vary based on a patient’s coverage, deductibles, co-payments and co-insurance. An uninsured patient may be eligible for a reduced bill under the hospital’s financial assistance policy.

“These costs are best understood through a customized estimate based on specific information provided by the physician, a conversation with their insurance provider and guidance from one of our hospital financial counselors, who are available when services are scheduled or upon request,” Byrd said.

Colquitt Regional notifies patients on the estimated cost of what they may be expected to pay, based on their individual insurance coverage and financial information prior to their appointment, said Jim Matney, hospital CEO.

Colquitt County Hospital Authority, which governs Colquitt Regional and is appointed by Colquitt County Commission, has mandated the price of a procedure not increase by more than 3 percent from the previous year, he said.

“We call patients two or three days ahead of time telling them what we expect their portion to be,” Matney said. “We work with them to get them some type of public assistance.”

Copyright © 2019 Valdosta Daily Times

Source: Valdosta Daily Times

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