Sunday marked seven months since U.S. hospitals were required to publish price lists for procedures and services, in which time tri-state hospitals have complied in their own styles.
Some experts, though, think it will take patients changing how they approach their health care to see real results of the price transparency rule.
The new federal rule, enforced by U.S. Centers for Medicare and Medicaid Services, went into effect as of Jan. 1 of this year and brought a brand new requirement for hospitals. They were required to post lists of base costs for more than 300 common procedures.
Hospitals were generally against the rule, with the American Hospital Association and other groups suing the federal government over the mandate. Those efforts have thus far failed to reverse the rule, however.
And while the rule stemmed from former President Donald Trump’s administration, current U.S. President Joe Biden bolstered it in his executive order “on promoting competition in the American economy.” In the order, Biden directed the U.S. Department of Health and Human Services to support the hospital price transparency rule.
Nationally, hospitals appear to have had a slow start. The national nonprofit Patient Rights Advocate group recently released a report finding that 94.4% of the 500 hospitals they studied had not yet fully complied with the rule.
No tri-state hospital was included in that study however. Investigating area hospitals’ websites show that all are compliant, even if they each have a different style.
MercyOne Medical Centers in Dubuque and Dyersville offer portals for standard charges under a price estimate tab from the billing and financial information section of their site. That features a list of gross charges and discounted prices if paying cash. But once in the portal, would-be patients can also filter the list of procedures by their insurance payer and by if they will be inpatient or outpatient, resulting in different costs.
“We have also expanded our online tools to help patients estimate their out-of-pocket costs for hospital services by factoring in their insurance coverage and health plan deductible and co-insurance,” said Jennifer Faley, MercyOne’s regional communications lead. “The cost estimate tool on our website can estimate a patient’s financial responsibility for hospital charges for at least 300 common services based on their insurance situation.”
On UnityPoint Dubuque-Finley Hospital’s website, a user first selects a general category from a grid of options — behavioral health, cardiology, digestive health, immunization, etc. Then a detailed grid of clickable procedure options appears for a patient’s selection. The patient then selects their insurance, and enters their name and member number. Then, a price appears.
“As an organization, UnityPoint Health believes in making the cost of care easier to understand, and we strive to provide a positive financial experience for our patients,” UnityPoint Health sent in a written statement from their system. They did not allow for an interview with an employee.
Southwest Health, in Platteville, offers a link to a spreadsheet with the gross and cash discount costs of procedures to close detail — including length of mental health sessions or size of skin abrasion.
Midwest Medical Center, in Galena, offers a link to a spreadsheet as well, but one that includes columns with costs for every health insurance plan they accept, for each procedure listed.
These widely varying styles are fine, according to CMS answers to frequently asked questions — “The format is the hospital’s choice as long as the information represents the hospital’s current standard charges as reflected in its chargemaster.”
Each hospital also has financial services staff available to provide detailed cost estimates and negotiate prices with patients.
UnityPoint Health remains skeptical of the impact of the new rule.
“Consistent with the industry and other hospitals in our local markets, we remain concerned that the required hospital charge data — including thousands of different sets of negotiated insurance contract rates — is overwhelming for patients and offers little value in understanding their true costs following a hospital stay or service,” their statement read. “Hospital charges alone do not provide a complete picture of what patients owe.”
The Iowa Attorney General’s Office handles consumer complaints from patients. Chief of Staff Lynn Hicks told the Telegraph Herald that the office supported the rule, but had heard little about it from patients.
“It’s a good step forward for patients and consumers,” he said. “Since it is so new, I don’t think a lot of people know about it yet. Before, there wasn’t any expectations that people could find the price ahead of time.”
Diane Pape-Freiburger, of Dubuque, has been connected to local health care her whole adult life. She has been a nurse, in management at health care providers and now vice chairs the Dubuque County Board of Health. She too said looking for prices ahead of time is not how most people think of care when they need it.
“In an emergency situation, you go into the hospital and trust that you’re not going to have surprise charges and that your insurance will cover what they can,” she said. “If you don’t have insurance, when you go to a non-profit hospital especially, there are so many ways for that bill to be paid, even if you can’t.”
Both said that these new price lists will take changing the way residents think of care before they receive it. But now there is an option.