More than 10 months after the Centers for Medicare and Medicaid Services asked hospitals to provide the public with user-friendly pricing information for their medical services, the majority of hospitals in San Diego have not fully complied.
As of January 2021, hospitals and healthcare facilities operating in the United States are required to provide legible and complete pricing information on their websites for at least 300 services that can be purchased. If a hospital offers fewer than 300 services, it should list as many purchasable services as it provides.
The rule was created in the hope that price transparency would encourage consumers to compare the prices of procedures before deciding where to seek treatment.
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Just as consumers research a car or plane ticket before they buy, regulations on price transparency put the agency in the hands of patients and decrease the likelihood of being caught off guard by a surprisingly high bill.
Although the rule was passed under the Trump administration, it has received bipartisan support, with President Joe Biden vowing to ensure all hospitals are compliant.
Despite broad political support, Turquoise Health, an organization that scans hospital websites for compliance and aggregates the information into a database, found that out of about 6,000 hospitals in the United States, only about 3,300 hospitals have published files so far.
newsource reviewed a recent audit conducted by Turquoise Health and was able to verify its findings that out of 24 San Diego County hospitals and health facilities, only four were fully compliant with the Centers for Medicare and Medicaid Services ruling.
The remaining 20 health facilities had either not uploaded the prices or published only partial information.
In order to be fully compliant with the law, healthcare providers must publish the spot price for each procedure, as well as any rates negotiated by each payer and each health plan that a given hospital accepts.
Hospitals fully audited by Turquoise Health include Alvarado Hospital, Kaiser Foundation-San Diego Zion Medical Center, Rady Children’s Hospital San Diego, and Sharp Mesa Vista Hospital. The government intends to audit a sample of hospitals and could impose significant fines for non-compliant facilities.
In a statement to news source, Ben Metcalf, communications project manager at Rady Children’s Hospital, expressed the hospital’s commitment to establishing a transparent relationship between its patients and the facility.
âWe recognize how important it is for patients and their families to have the information they need about the cost of care within our system. As part of this effort, we are helping patients and their families understand the charges they may see when they visit any of the hospital departments, the ongoing charges for inpatients and outpatients, and the potential charges. associated with all health services, âsaid Metcalf.
The push for price transparency comes amid nationwide consumer panic over health care costs. Following the massive layoffs due to the COVID-19 pandemic, many have lost the health insurance coverage they once held through their employers.
In June, a study by the Journal of American Medical Association showed consumer panic was justified. The newspaper found that Americans have $ 140 billion in medical debts, making health care the nation’s largest source of debt.
Reasons for non-compliance
According to Marcus Dorstel, operations manager at Turquoise Health, the organization has seen geographic trends in non-compliance since the law came into effect. Hospitals in a given area often wait to see if their surrounding competitors download first.
Some healthcare establishments fear that the publication of prices will first attract public attention and negative attention.
But Dorstel said the concern underscores the importance for hospitals to understand where they are in the market and how their prices compare.
âAt the end of the day, you can have higher prices,â Dorstel said, âbut you have to justify those prices. Maybe you have the best doctors, the best surgeons, and the best medical devices. Then there is has a good reason why you charge 150% more than others, but it’s about controlling that narrative. â
The American Hospital Association recognizes the importance of price transparency, but says the pandemic has made compliance difficult for some hospitals.
In a statement to newsource, a spokesperson for the association said: âFor many hospitals, implementing the negotiated rate disclosure portion of the price transparency rule requires significant human resources who have had to stay focused on the response. COVID-19. â
However, some are skeptical of what they see as an apology. âFrankly, it’s all about the money. Because they make so much money, âsaid Cynthia Fisher, Founder of PatientRightsAdvocate.org.
The price transparency decision represents a transfer of power from hospitals and insurance companies to the consumer – a transfer of power that healthcare providers say will reduce their profits, sources said.
Unnecessary spending by employers
Providing employee health care options is one of the biggest costs employers face.
Jim Jusko, founder of FireLight Health, an online healthcare price comparison tool, says the lack of price transparency is very damaging to businesses.
âI think the biggest problem in American health care really is the massive and unintentional overspending that employers have to make,â Jusko said.
The rising cost of health insurance has made it difficult for employers to offer substantial health benefits to employees. The price transparency decision is intended to encourage employers to shop around for coverage options and choose the most appropriate plan based on their budget and the needs of their employees.
But the publication of health care costs has the potential to disrupt the relationship between hospitals and insurance companies.
âIf a hospital sells hip or knee surgery to Humana at that price, but United Health Care at that price, you’d rather both of your customers not know what prices you are selling these items at,â Dorstel said, âBecause one of them gets a better deal than the other. “
Consumers have been left in the dark
But negotiations with hospitals and insurance companies ultimately impact consumers’ pockets.
âIt comes from our paychecks, our salaries and our contributions to insurance premiums. Hospitals get away with insurance companies because they both make money by maximizing their profits, âsaid Fisher, of PatientRightsAdvocate.org.
Historically, the healthcare system has not encouraged or allowed a consumer mindset. Consumers are often unaware of the wide range of prices between hospitals for the same procedures.
Sacramento’s Sutter Medical Center came under fire earlier this year when it was discovered that a standard Caesarean procedure cost one woman $ 6,000.00 and another woman over $ 60,000.00.
Cynthia Fisher said the price transparency decision holds hospitals accountable for massive price differentials like these.
âNone of us would tolerate paying 10 times more for a gallon of milk at the grocery store than the person in line in front of us,â Fisher said.
“So when we see these prices, we will not tolerate being overcharged by the next person 10 times for the same service by the same providers.”
While compliance remains low, the Centers for Medicare and Medicaid Services are pushing to increase the penalty for non-compliance. According to a spokesperson for the agency, as of September 1, it had issued around 256 warnings to hospitals that were deemed not to comply with regulations on transparency of hospital prices.
The agency has proposed higher penalties for non-compliant hospitals. Under their proposed approach, a full calendar year of non-compliance would result in a minimum penalty of $ 109,500 per hospital and a maximum penalty of over $ 2 million per hospital. Penalty amounts would be determined by the size of the hospital.
If finalized, the increase in the penalty will take effect on January 1, 2022.
For now, the Centers for Medicare and Medicaid Services are delaying issuing and increasing penalties in the hopes that hospitals simply need more time to comply.