Hos­pi­tals must pub­lish prices, but data can be mis­lead­ing

The Island Packet - - Local - BY JAMIE SELF [email protected]­tate.com

Ever wanted to know what hos­pi­tals charge for that open heart surgery or to keep a loved one on life sup­port?

Hos­pi­tals are of­fer­ing some in­sight into those costs. Start­ing Jan. 1, all hos­pi­tals were re­quired to pub­lish on­line what they charge for the med­i­cal pro­ce­dures and other ser­vices they pro­vide.

The rule is aimed at mak­ing the cost of health care more trans­par­ent, Pres­i­dent Don­ald Trump’s health sec­re­tary has said. But the in­for­ma­tion isn’t easy to ac­cess or in­ter­pret, and does not show con­sumers what health care re­ally costs them, ex­perts say.

“This is not ac­tion­able data for the pub­lic,” said Schipp Ames, spokesper­son for the S.C. Hos­pi­tal As­so­ci­a­tion. “It gives you some idea of the costs. It might take away some sticker shock.”

The price lists, down­load­able in mas­sive spread­sheets that in­clude some­times tens of thou­sands of rows of data, are each hos­pi­tal’s in­ter­nal charge sheet, Ames said. The charge de­scrip­tions use med­i­cal lan­guage and are de­vel­oped by each hos­pi­tal for in­ter­nal use, mak­ing it dif­fi­cult to match de­scrip­tions and to com­pare costs across hos­pi­tals.

Hos­pi­tals chose the spread­sheet for­mat to meet the fed­eral re­quire­ment of be­ing “ma­chineread­able,” mean­ing in a for­mat that could be loaded into a com­puter data­base pro­gram for anal­y­sis.

The price lists fall short of be­ing use­ful in one other big way, ex­perts say.

“Other than a poor, un­for­tu­nate, com­pletely unin­sured soul who winds up on the steps of one of these med­i­cal providers, no­body ac­tu­ally pays these prices,” said Robert Hartwig, a health in­sur­ance ex­pert at the Univer­sity of South Carolina’s Darla Moore School of Busi­ness.

The charges that hos­pi­tals are post­ing on­line re­flect their higher sticker prices for ser­vices, not what hos­pi­tals even­tu­ally get paid after ne­go­ti­at­ing fees with in­sur­ance com­pa­nies, Hartwig said. Leav­ing con­sumers even more in the dark, the prices in­sur­ers ne­go­ti­ate with providers is se­cret.

Con­sumers get some in­sight into those costs, and how much gets passed on to them, after they’ve been treated and re­ceive a bill for what they owe, Hartwig said.

“Health in­sur­ance is the most ex­pen­sive thing that

you pay for and have no idea what the cost is,” Hartwig said.

Com­par­ing two ma­jor Mid­lands hos­pi­tals shows just how dis­parate the data is. For ex­am­ple:

Lexington Med­i­cal Cen­ter re­ported 23,393 pro­ce­dures. Pal­metto Health Rich­land re­ported 62,904.

The most ex­pen­sive pro­ce­dures at Lexington Med­i­cal are $524,945 for life sup­port and $343,380 for a ma­jor heart surgery.

At Pal­metto Health, the most costly pro­ce­dure is what ap­pears to be a type of heart surgery at $187,225. Mean­while, a rad­i­cal nephrec­tomy — the re­moval of the en­tire kid­ney, ac­cord­ing to the Cleve­land Clinic — costs $17, a price that seems highly un­likely.

Asked to clar­ify, a spokesper­son with Pal­metto Health said there wasn’t a more de­tailed ex­pla­na­tion of pro­ce­dures avail­able.

Real progress in mak­ing health care costs trans­par­ent would be shar­ing with con­sumers de­tails about the fi­nan­cial agree­ments be­tween in­sur­ance com­pa­nies and health care providers, Hartwig said, adding con­sumers then would have a bet­ter idea of whether they’re get­ting a good deal.

That trans­parency could help con­sumers and cre­ate more com­pe­ti­tion and lower costs, said Lynn Bai­ley, a Columbia-based health econ­o­mist.

“Mar­kets only work when buy­ers and sell­ers have in­for­ma­tion about each other,” Bai­ley said. “Health care is not a mar­ket and will not ever be a mar­ket be­cause of in­for­ma­tion asym­me­try, which means one side or the other has cor­nered the in­for­ma­tion.”

VISIVASNC Getty Images/iS­tock­photo

Ex­perts say a new rule re­quir­ing hos­pi­tals to pub­lish what they charge won’t show con­sumers the true cost of care.

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