Cost of care: These Tennessee hospitals aren't following federal pricing rules, report says
Hospital stays are expensive. But a new report finds that most U.S. hospitals, including some of Tennessee's premier health centers, aren't abiding by a 2021 federal rule requiring them to tell the public just how much such stays will hit their pocketbooks.
The non-profit price transparency group, Patient Rights Advocate (PRA) finds in its fifth semi-annual report that only 36% of hospitals are following the federal rule requiring, among other things, that health centers provide "clear, accessible pricing information online."
PRA also found that only half of Tennessee hospitals fully complied with the federal rule, though the state as a whole ranks as the 10th best for hospital compliance, the report said.
Advocates for price transparency argue that it could help drive down the cost of health care by giving patients the ability to shop around for care.
“Unfortunately, our findings show that the majority of hospitals across the country are still failing to comply with the Hospital Price Transparency Rule,” said Cynthia Fisher, founder and chairman of PRA, in a written statement. “When hospitals hide behind estimates or don’t post all real prices, they are leaving consumers in the dark. Making all actual prices available upfront will empower patients, employers, and unions to choose the best care at prices they know they can afford, and protect all Americans from overcharges, errors, and fraud."
Federal regulators said this spring they have issued 730 warnings to hospitals and 269 requests for corrective action plans. But, more than two years after the rules have gone into effect, the government has fined only four hospitals for non-compliance, according to the Centers for Medicare and Medicaid Services.
None were in Tennessee.
What does 'price transparency' mean?
For years, the best information on hospital pricing the public could get was from so-called "chargemaster" lists, which are essentially the base prices for procedures. But those listed prices usually bear little resemblance to what patients pay out-of-pocket after insurance negotiations with hospital billers.
The new federal rules, which took effect in January 2021, require "a comprehensive machine-readable file with all standard charges established by the hospital for all the items and services it provides."
The rules also state that health centers must provide "consumer-friendly" displays of actual prices for 300 common procedures and/or by providing cost estimators that can be personalized for patients.
Which Tennessee hospitals are 'transparent?'
According to PRA, the following hospitals are fully complying with the federal price transparency rules:
Baptist Collierville, Baptist Memorial Hospital - Caroll County, Baptist Memorial Hospital - Memphis, Baptist Memorial Hospital - Tipton, Baptist Memorial Hospital - Union City, Baptist Memorial Hospital for Women, Bristol Regional Medical Center, CHI Memorial Hospital Chattanooga, CHI Memorial Hospital Hixson, Erlanger Baroness Hospital, Holston Valley Medical Center, Indian Path Community Hospital, Jefferson Memorial Hospital, Johnson City Medical Center, Methodist University Hospital, Riverview Regional Medical Center, Southern Tennessee Regional Health System - Lawrenceburg, Southern Tennessee Regional Health System - Pulaski, Southern Tennessee Regional Health System - Sewanee, Southern Tennessee Regional Health System - Winchester, Starr Regional Medical Center Athens, Sumner Regional Medical Center, Tennova - LaFollette Medical Center, Tennova - Newport Medical Center, Tennova - North Knoxville Medical Center, Tennova Healthcare - Cleveland, Tennova Healthcare Clarksville, Tennova -Turkey Creek Medical Center, Trousdale Medical Center, University of Tennessee Medical Center, and West Tennessee Healthcare Jackson - Madison County General Hospital.
And those that aren't...
PRA concludes that no hospital owned by Nashville-based HCA Healthcare is compliant with the rules. That includes those health centers under the TriStar brand.
Anna-Lee Cockrill, a spokeswoman for TriStar, said Monday the federal government determines compliance, not groups like PRA. Cockrill said HCA provides costs estimates for its patients and argues, like other hospital groups, that organizations like PRA use flawed methodology to determine "compliance."
As the hospital trade group, the Federation of American Hospitals puts it: "They deemed a hospital non-compliant if just one of the hundreds of data fields was left blank."
"Our hospitals implemented the federal requirements in January 2021," Cockrill said. "Since then, our hospital websites have included a consumer-friendly Patient Payment Estimator tool that provides relevant information to help patients understand what their out-of-pocket responsibility may be for hospital care, including those that are uninsured."
The group also found the following Ascension Saint Thomas hospitals noncompliant: West (Nashville), Stones River Hospital (Woodbury), Rutherford (Murfreesboro), River Park (McMinnville), Midtown (Nashville), Highlands (Sparta), Hickman (Centerville) and DeKalb (Smithville).
A spokesperson for Ascension did not respond to a request for an interview.
The report also called out Vanderbilt University Medical Center and its Monroe Carell Jr. Children's Hospital at Vanderbilt. But VUMC spokesman John Howser says the report misses the mark. Howser notes that the hospital provides online cost estimators for hospital and out-patient services.
"We want to be upfront with patients about what care is going to cost out-of-pocket and for patients to better understand their insurance benefits and what their potential costs might be," Howser said in an email. "Vanderbilt University Medical Center’s patients have multiple options to explore out-of-pocket costs for most procedures and services."
Frank Gluck is the health care reporter for The Tennessean. He can be reached at fgluck@tennessean.com. Follow him on Twitter at @FrankGluck.
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This article originally appeared on Nashville Tennessean: Why many Tennessee hospitals aren't transparent about pricing | Report
