With much fanfare, federal officials required hospitals nationwide this season to post their “list” prices online. But it is not yet clear the number of are doing it, even as the federal government has taken the rare step of asking consumers to monitor hospital compliance.
Most hospitals seem to be adhering to the rule, according to hospital officials along with a small sampling of websites.
However, the feds acknowledge they are not yet enforcing the rule, industry groups aren't monitoring compliance, many hospitals are burying the information on their own websites, and debate continues about whether the price lists are coming up with more confusion than clarity among consumers.
The rule took effect Jan. 1, following a year-long controversy about its necessity and usefulness. It takes every hospital in the united states – about 6,000 – to post its top dollar list online.
The lists, known in the industry as “chargemasters,” present prices for the a large number of individual products and services for which a medical facility may bill – from the price of a bed per day, blood tests and surgical operating room time (billed in 15-minute intervals) towards the cost of just one Tylenol tablet.
The problem: Products and services are identified in obscure abbreviations, billing codes and medical terminology that even doctors or nurses often don't understand.
Additionally, the chargemaster lists only rarely reflect final billed charges because insurers and the government generally negotiate significantly affordable prices. Generally, these posted rates are the highest a hospital would ever charge per service.
Even so, officials in the Centers for Medicare & Medicaid Services (CMS) said full public disclosure was a logical initial step in a transparency initiative aimed at eventually encompassing physician and prescription medication prices.
CMS contends the listings will help patients compare facilities, spur competition among hospitals to lower prices and prompt software developers to construct tools that consumers can use to shop around.
“We think this information will empower patients,” said Seema Verma, the CMS administrator. “And good quality to seeing consumers continue to drive the demand for hospitals to supply greater price transparency.”
Verma has enlisted the public within an unusual effort to monitor whether hospitals are complying. In appearances, opinion pieces and through social networking, she has urged customers to check their local hospitals' websites to see if chargemaster lists are posted and allow the agency know if they are not.
While putting off enforcing the law, CMS has instead invited hospitals, other health care stakeholders and also the public to weigh in on possible enforcement mechanisms, in addition to suggest future price transparency measures. Countless comments have been submitted.
At the agency-initiated Twitter site #WheresthePrice, a dialogue has ensued. In one case, a Texas man, Matt Kleiber, checked 31 hospitals and medical centers in Houston and located one health system, Memorial Hermann, which operates 16 hospitals, not in compliance.
After a reporter's inquiry, Kathryn Williams, a spokeswoman for Memorial Hermann, said in early February the hospital system was at compliance. She said they interpreted the government's rule as allowing a shorter, easier-to-understand price list to be posted.
Subsequently, in late February, the hospital posted its full chargemaster list, as the regulation requires.
“What we posted [initially] was much easier for our patients to know,” said Williams. “We don't believe the chargemaster list is helpful – and that we uphold our position that the information we have had posted on our website since Jan. 1 is consistent with CMS's guidance.”
Other reports of noncompliance at #WheresthePrice appeared to be the result of incomplete website explorations by consumers. A KHN check from the websites of six cited hospitals showed the cost lists were posted. On all but one of the sites, however, the data wasn't prominently displayed.
About a dozen hospital websites reviewed by KHN included an accompanying – and frequently prominent – disclaimer saying the data doesn't reflect typical final charges and it is difficult to understand.
Accompanying its chargemaster list, for instance, Saline Memorial Hospital in Benton, Ark., states: “The amount listed [for each service] isn't necessarily reflective of the actual financial responsibility. – It is recommended that all patients contact their insurer or Saline Health System to go over their individual situations and see the potential out-of-pocket costs of the care.”
Ariel Levin, senior associate director of state issues in the American Hospital Association (AHA), said hospitals happen to be reluctant to draw too much focus on their price lists.
“Most hospitals think this information will not help patients,” Levin said. “And many think it only confuses people.”
Levin said the AHA is not monitoring its members' compliance, and she doesn't think other hospital trade groups are either.
“But all of the hospital websites we have checked to date have been in compliance, and that we believe the vast majority are following the rule,” Levin said. Small rural hospitals may take longer to comply, she added.
CMS and the AHA said a few hospitals offer consumer-friendly price transparency that goes significantly beyond the chargemaster price lists.
St. Luke's University Health Network, a 10-hospital system with 300 outpatient clinics in Pennsylvania and Nj, several years ago launched an online tool with two features, “PriceLock” and “PriceChecker.”
Francine Botek, the hospital's senior vice president for finance, said PriceLock allows patients to get an all-inclusive price for many – 80 percent – of the hospital's outpatient services even if a patient doesn't enter insurance information. PriceChecker lets people to enter insurance information along with other data to assist calculate their out-of-pocket costs.
The tools are just slowly gaining traction among consumers, said Botek. In 2021, 35,200 people used PriceChecker, averaging about 2,500 a month. Over the past three years, about 3,600 used PriceLock.
The University of Utah, which owns four hospitals, includes a similar online out-of-pocket cost estimator for about 600 common (mostly outpatient) services and procedures – giving a single price that rolls up itemized charges for each. People with or without insurance may use the tool. Those without insurance get an across-the-board 30 percent discount off the list price, and deeper discounts are sometimes available.
Kathy Delis, who oversees billing at University of Utah Health, said the hospital system plans this season to market the tool to the public more aggressively.
“It's likely to take time to engage patients,” Delis said. “We have urged CMS to maneuver beyond the chargemaster rule as quickly as possible.”
A few states require hospitals to give consumers price estimates. The laws are restricted in scope, however. In 2021, Colorado became the latest state to enact this type of law. It necessitates that hospitals post “self-pay” prices for that 50 conditions that yield probably the most revenue from Medicare. Doctors must also post prices for their 15 most widely used procedures.
An older California law requires hospitals to disclose prices for the top 26 outpatient services by revenue.
A spokesperson for CMS said the agency plans to issue its next regulation on hospital price transparency this season.