It may take a brain sur­geon to make sense of hos­pi­tal price lists

The Buffalo News - - FRONT PAGE - By Robert Pear

WASH­ING­TON – Vanderbilt Univer­sity Med­i­cal Cen­ter, re­spond­ing to a new Trump ad­min­is­tra­tion or­der to be­gin post­ing all hos­pi­tal prices, listed a charge of $42,569 for a car­di­ol­ogy pro­ce­dure de­scribed as “HC PTC CLOS PAT DUCT ART.”

Bap­tist Health in Mi­ami help­fully told con­sumers that an “Em­bolza Pro­tect 5.5” would cost them $9,818 while a “Vis­ceral se­lec­tive an­gio rad” runs a mere $5,538.

On Jan. 1, hos­pi­tals be­gan com­ply­ing with a Trump ad­min­is­tra­tion or­der to post list prices for all their ser­vices, the­o­ret­i­cally of­fer­ing con­sumers trans­parency and choice and forc­ing health care providers into price com­pe­ti­tion.

It’s turn­ing into a fi­asco. “This pol­icy is a tiny step for­ward, but falls far short of what’s needed,” said Jeanne Pin­der, founder and chief ex­ec­u­tive of Clear Health Costs, a con­sumer health re­search or­ga­ni­za­tion. “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.”

The data, posted on­line in spread­sheets for thou­sands of pro­ce­dures, is in­com­pre­hen­si­ble and un­us­able by pa­tients – a hodge­podge of num­bers and tech­ni­cal med­i­cal terms, dis­played in for­mats that vary from hos­pi­tal to hos­pi­tal.

It is nearly im­pos­si­ble for con­sumers to com­pare prices for the same ser­vice at dif­fer­ent hos­pi­tals be­cause no two hos­pi­tals seem to de­scribe ser­vices in the same way. Nor can con­sumers di­vine how much they will have to pay out of pocket.

“To 99 per­cent of the con­sum­ing pub­lic, these data will be of lim­ited util­ity – mean­ing­less,” said Ken­neth E. Raske, pres­i­dent of the Greater New York Hos­pi­tal As­so­ci­a­tion.

The list price for a hos­pi­tal ser­vice is like the sticker price for a car. But as it is play­ing out, it is as if the car deal­ers were dis­clos­ing the price for each auto part, with­out re­veal­ing the charge for the ve­hi­cle as a whole.

The re­sult has baf­fled con­sumers.

“This is gib­ber­ish, to­tally mean­ing­less, a for­eign lan­guage to me,” said Sara Sto­vall,

41, of Char­lottesville, Va., after look­ing at price lists for hos­pi­tals in her area.

She re­viewed the price lists for Sen­tara Martha Jef­fer­son Hos­pi­tal and for Univer­sity Hos­pi­tal, each of which has more than 16,000 items.

“I can’t imag­ine how I would go about mak­ing this use­ful,” Sto­vall said Sun­day. “I wouldn’t know how to find my pro­ce­dure. I wouldn’t know what ser­vices might be rolled up with my pro­ce­dure. And I would not know the price to me after health in­sur­ance.”

By most ac­counts, the Trump ad­min­is­tra­tion is pur­su­ing a wor­thy goal, but the ex­e­cu­tion of its plans leaves much to be de­sired.

After the ad­min­is­tra­tion pro­posed the price-dis­clo­sure re­quire­ment in April 2018, many hos­pi­tals warned of the short­com­ings that are now ev­i­dent.

But fed­eral health of­fi­cials, ac­cus­tomed to de­bat­ing is­sues in­side the Wash­ing­ton pol­icy bub­ble, have still been sur­prised at the re­ac­tion around the coun­try as con­sumers and lo­cal news me­dia try to de­ci­pher the data. The ad­min­is­tra­tion says it is open to sug­ges­tions for 2020 and be­yond.

The price-dis­clo­sure re­quire­ment, is­sued by the Depart­ment of Health and Hu­man Ser­vices, grows out of one sen­tence in the Af­ford­able Care Act, which says, “Each hos­pi­tal op­er­at­ing within the United States shall for each year es­tab­lish (and up­date) and make pub­lic (in ac­cor­dance with guide­lines de­vel­oped by the sec­re­tary) a list of the hos­pi­tal’s stan­dard charges for items and ser­vices pro­vided by the hos­pi­tal.”

The idea lan­guished for eight years. Un­der prior guid­ance from the gov­ern­ment, hos­pi­tals could meet their obli­ga­tions by pro­vid­ing charges to pa­tients on re­quest. But the Trump ad­min­is­tra­tion wanted to go fur­ther.

“We’ve up­dated our guide­lines to specif­i­cally re­quire hos­pi­tals to post price in­for­ma­tion on the in­ter­net in a ma­chine-read­able for­mat,” Seema Verma, ad­min­is­tra­tor of the Cen­ters for Medi­care and Med­i­caid Ser­vices, said last week. “This is a his­toric change from what’s been re­quired in the past.”

“This is about em­pow­er­ing pa­tients,” Verma said.

It has not worked out that way, at least so far. Martin Gaynor, a pro­fes­sor of eco­nomics and health pol­icy at Carnegie Mel­lon Univer­sity in Pitts­burgh, de­scribed list prices as “some­what fic­ti­tious.”

“If this is an ini­tial step lead­ing to real trans­parency with ac­tion­able, us­able in­for­ma­tion, that would be fan­tas­tic,” Gaynor said.

But in its cur­rent form, he added, the price in­for­ma­tion is “not very use­ful and could even be mis­lead­ing” be­cause a hos­pi­tal with high list prices could be the cheaper al­ter­na­tive for some con­sumers, de­pend­ing on their in­sur­ance.

“For pa­tients to know up­front how much their care will cost, that’s in­cred­i­bly valu­able,” said Brenda L. Reetz, chief ex­ec­u­tive of Greene County Gen­eral Hos­pi­tal in ru­ral south­west In­di­ana. “We’ve posted our prices, as re­quired. But I re­ally don’t think the in­for­ma­tion is what the con­sumer is ac­tu­ally want­ing to see.”

Spend­ing on hos­pi­tal care last year to­taled $1.1 tril­lion, or nearly one-third of all health spend­ing, ac­cord­ing to the Depart­ment of Health and Hu­man Ser­vices. So even small im­prove­ments in the mar­ket could yield big sav­ings.

The Trump ad­min­is­tra­tion told hos­pi­tals that they had to post their stan­dard charges for all ser­vices and items, in­clud­ing drugs, by Jan. 1, but did not de­fine “stan­dard charges.” In later guid­ance, it said the for­mat was “the hos­pi­tal’s choice.”

“With­out a stan­dard def­i­ni­tion, pa­tients can­not make ac­cu­rate com­par­isons be­tween hos­pi­tals,” said Herb B. Kuhn, pres­i­dent of the Mis­souri Hos­pi­tal As­so­ci­a­tion.

No hos­pi­tals op­er­at­ing in the United States are ex­empt from the new re­quire­ment, but the Trump ad­min­is­tra­tion has not said how it plans to en­force it. Fed­eral of­fi­cials have asked the pub­lic to sug­gest “en­force­ment mech­a­nisms.”

Even while com­ply­ing with the new re­quire­ment, many hos­pi­tals have posted dis­claimers warn­ing con­sumers not to rely on the data.

The Univer­sity of Texas MD An­der­son Can­cer Cen­ter, for ex­am­ple, says that it “does not war­rant the ac­cu­racy, com­plete­ness or use­ful­ness” of the charges listed on its web­site.

If hos­pi­tals have com­plaints about the new re­quire­ments, Verma said, they should vol­un­tar­ily pro­vide pa­tients with more use­ful in­for­ma­tion.

“Hos­pi­tals don’t have to wait for us to go fur­ther in help­ing their pa­tients un­der­stand what care will cost,” she said.

New York Times

Howard Univer­sity Hos­pi­tal in Wash­ing­ton, D.C., has posted list prices, but that may not help con­sumers.

Tri­bune News Ser­vice

“For pa­tients to know up­front how much their care will cost, that’s in­cred­i­bly valu­able,” said Brenda L. Reetz, CEO of Greene County, Ind., Gen­eral Hos­pi­tal, but she doubts that gov­ern­ment-man­dated price lists will help pa­tients.

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