REGIONAL—Wondering about the cost of hospital visit before the bill arrives in the mail?
As of Jan. 1, a federal law requires all U.S. hospital to post the standard charges for all services they provide online.
The 2019 Inpatient and Long-Term Care Hospital Prospective Payment System requirement set forth by the Centers for Medicare & Medicaid Services focuses on providing better services to patients through price transparency.
Hawarden Regional Healthcare director of finance and compliance officer Jessica Hughes said price transparency is important in health care.
“We have always tried our best to communicate with patients what their overall out-of-pocket cost is if they receive care at our facility,” Hughes said. “However, in the past that was only if they asked. This requirement forces our hand to do more. This isn’t a bad thing. However, hospitals weren’t entirely ready to go out and publish their entire chargemaster due to the complexity of it.
“Because of this requirement, we immediately started thinking of how we can make our charges available to the public that would give them meaningful information according to what they need.”
Hughes said Hawarden Regional Healthcare plans to implement a patient liability estimator on the website by the end of February. The estimator will allow anyone to enter personal health-care coverage information and what service is needed. Hughes said the estimator will then provide an estimate of out-of-pocket expenses.
Sioux Center Health chief financial officer Kari Timmer said list prices for her facility will be updated annually in January; thus, available prices on the website may not be up-to-date all the time.
Johnny Tureaud is the director of patient access and financial services for Mercy Medical Center in Sioux City, of which Baum Harmon Mercy Hospital in Primghar is a subsidiary. He has a mixed opinion on the CMS requirement.
“On the one hand, I believe it is important for consumers to have information related to the costs of the health-care services they receive,” Tureaud said. “However, it can often be difficult and confusing for someone not familiar with health-care billing and insurance coverage to determine their actual ‘out-of-pocket’ cost.”
Orange City Area Health System CEO Marty Guthmiller said he supports transparency and that the CMS requirement has good intentions, but it will ultimately not be helpful to patients.
“Health care is deeply personal,” Guthmiller said. “Every individual, even when receiving what is a ‘standard’ service or procedure, has specific medical need. Each encounter must be tailored to each situation.
For example, a surgical procedure may or may not include the type of anesthesia required. It may or may not require a stay in the hospital or include a certain regimen of medication,” he continued. “An individual’s care team is involved in each aspect of a person’s medical service. In addition, a very complicated insurance structure — with bundled charges and various other rules — make it difficult for a consumer to accurately know their charges. Estimates, or ranges — in consultation with our billing staff — are much more achievable.”
The purpose of requiring hospitals to make prices available is so patients can compare and decide which facility to go to.
Sioux Center Health CEO Cory Nelson said health-care consumers are no different from consumers of other services in that they want to know what they are going to get for their money.
“On the surface, price transparency seems like a logical approach,” he said. “In reality, people have different insurance plans and their care needs can vary greatly depending on the complexity of their health-care needs. It is critically important for people to communicate directly with their provider and the facility providing the service to determine the best cost estimate for their care.”
The Sioux Center chargemaster list is 148 pages. The most expensive item is “radiophar capromab pendetide” which is a radiopharmaceutical — or radioactive compound — used as an imaging agent to diagnose, localize and stage prostate cancer. It is priced at $5,774.
Charges, names vary
However, hospitals do not use the same chargemaster, or format, when it comes to making prices available. Hospitals also call the same services or items by different names.
For example, Sanford Rock Rapids Medical Center has a critical care room, which carries a charge of $2,563. The Sanford Rock Rapids list is not as comprehensive as other hospitals, and is only 13 pages long. The most expensive item is “CTA ABD pelvis W contrast + WO if perform” and carries a price of $4,584. That is a computed topographic angiograph of the pelvis with and without contrast.
Sibley’s Osceola Community Hospital 76-page chargemaster lists “Room ICU,” which stands for intensive care unit and is the same as a critical care room. The charge at Osceola Community is $1,641.89. The most expensive item on the Osceola Community Hospital list is “lap hysterect W/rem tube/ovary” at a cost of $7,628. That is a laparoscopic hysterectomy, which is performed with tiny incisions and a telescope.
Sometimes, the items on the list are difficult for the layman to understand. Hughes said one thing she does not like about the Hawarden Regional Healthcare list is that people who are not familiar with health-care verbiage will have to interpret the information. While compiling the list did not take a lot of time, what did was going through and making it meaningful to those who want to utilize it. She hopes the patient liability estimator will help people navigate the list.
The Hawarden list contains 65 pages and is broken down into individual chargeable items. Hughes said prices will vary depending on a variety of things such as the type of care provided, treatments and the health condition of the individual. Some of the Hawarden items include “first-degree burn” at $168.95 and “vaginal delivery only” priced at $4,363.65. It also includes many medications, something not all hospitals in N’West Iowa listed. One common over-the-counter medication that is listed is a 30-milliliter dose of Pepto-Bismol for $2. A common prescribed antibiotic is amoxicillin and Hawarden has an 875-milligram tab priced at $4.
Hawarden had the most expensive listed item out of the seven N’West Iowa hospitals contacted by The REVIEW. That item was a $14,000 400-milliliter bottle of 40-milligram immune globulin, which is a replacement therapy derived from human plasma and used in the treatment of various autoimmune diseases and other ailments such as multiple sclerosis and lupus.
Not all hospitals have the same services. One example would be Osceola Community Hospital, which does not offer labor and delivery. The facility ended that service in 2018 after years of declining birthrates.
Osceola Community Hospital CEO Ben Davis said comparing charges is difficult.
“The chargemaster titles and codes can include different services or supplies making it difficult, if not impossible to compare,” he said. “The requirement does not change the complexity of health care and only makes pricing more confusing.”
Timmer stressed that the prices listed are just that.
“A procedure is not a set procedure and an amount — take our tubals for example — is not a procedure,” she said. “It is a cost based on time, adds in anesthesia time, supplies, etcetera and is not just one charge; it can be multiple.”
Timmer said someone should not look at the prices and then expect those prices to show up on their bill.
Not only can the comparison be incredibly difficult, but the prices each hospital lists is the fixed price, meaning it is not necessarily the price a patient will be charged. Whether or not a patient has health insurance, what insurance company they have and how much the insurance will cover all effects the charge that the patient is ultimately charged.
Davis said insurance companies negotiate price of charges or pay a fixed amount for each service, which is why most people do not receive the full hospital charge.
“In general, prices may vary due to cost of the medical equipment, cost of the physician, supplies, staff, utilities, etcetera,” Davis said. “All of these costs effect the charge on the list. However, rarely do we actually receive the total amount of the charge.”
Tureaud agreed, saying the price a patient is charged depends on the insurance plan he or she has. The Baum Harmon list contains 346 pages, with the most expensive item being 100 milligrams of Alteplase, a drug used to treat heart attacks. It is priced at $11,671.75.
“In general, the patient’s payment may be a co-payment, deductible or a percentage of the charge, depending on how their insurance plan is structured,” Tureaud said. “The amount that a patient may owe can further be affected by the setting or location of the health-care good or service they received.”
Another aspect that can impact what a patient is charged is the complexity of care. Nelson said a patient could come in for a specific procedure, and while that is going on, some other problem could be detected and then needs to be addressed.
“It is similar to taking your car in for routine service and they find something else that really needs fixed because if it is not, it can create a safety hazard or lead to even more expensive repairs later,” Nelson said.
The Orange City Area Health System list is 110 pages. The most expensive item is $10,400 for medication therapy management services.
“The prices for services are established to account for all the costs required to take care of the people in our communities — from direct patient care to cleaning the floor or shoveling the sidewalks,” Guthmiller said. “All the costs — including nonchargeable costs — are factored in to running a quality health-care facility. Simply, our goal is to make two or three cents on each dollar of revenue generated that can be reinvested back into equipment, services and personnel. Ensuring that we can remain viable and continue to offer a continuum of top-quality, patient-centered care is our priority.”