Disclosing prices for medical procedures could lower costs, but not all hospitals do
- Oops!Something went wrong.Please try again later.
When Bob Jewell opened a consulting firm out of his home in West Chester more than 20 years ago, the most challenging obstacle was selecting an insurance provider and shopping for health care.
He wanted to ensure his workforce, albeit a small one, had the best care at an affordable price.
But the process, he found, was extremely difficult. In 2001, he said, he paid $220 a month for coverage of a family of four. In 2021, he was paying $2,348 for just he and his wife. Shopping around for individual procedures to save money is even more challenging.
More: 'I don't want to be gouged.' Cincinnati region's hospitals charge wide range for care
Price transparency has become a bipartisan effort in Washington, D.C., today, something rare in the current political climate. It started with a provision in the Affordable Care Act from President Barack Obama, was expanded and signed into law by President Donald Trump, and was recently expanded again by President Joe Biden.
But nearly three years into federal law, many hospitals remain noncompliant with the law. Many are barely complying with inconsistently updated and convoluted data files, and hospitals rarely face enforcement for not complying with the law.
There's also a case to be made that the law, even under full compliance, isn't as effective as it intended to be.
"It's one of those feel good legislations that makes you and I think we can get a menu of prices and use it when we're going to make decisions about health care," Jewell said. "And anybody that knows health care, knew that that was an absolute pipe dream."
Hospitals slow walk compliance, head in right direction, report says
Patientrightsadvocate.org is a nonprofit that has been tracking compliance since the federal law's inception. While compliance rates have improved over the past two years, only 36% of hospitals are currently fully complying, according to the organization's latest report.
"We're going in the right direction," said the nonprofit's founder Cynthia Fisher. "We want to get to a place where we have search engines allowing us to know what is the price of an MRI, where could you go get an MRI at any hospital and what would you pay?"
The organization's latest report names many hospitals in the Cincinnati region as being "noncompliant" to the federal transparency law but the local hospitals dispute those findings.
According to the organization's report on hospitals in Ohio, eight hospitals in the Cincinnati region are not fully compliant to the federal law for varying reasons.
Those hospitals include:
TriHealth's Bethesda North and Good Samaritan Hospital.
Cincinnati Children's Hospital Medical Center.
Mercy Health's Anderson, Clermont, West and Jewish Hospitals.
University of Cincinnati Medical Center.
The report listed Christ Hospital as compliant.
The hospitals maintain they are complying with law requirements, while the nonprofit argues many of the hospitals are not disclosing as many negotiated rates as they should under the law.
In separate statements, Mercy Health, TriHealth, Cincinnati Children's, and UC Health all wrote that the nonprofit's report is "inaccurate," and maintained that their hospitals are in compliance. The discrepancy lies in each's version of what constitutes an "adequate" amount of negotiated rates under the law.
"TriHealth is fully compliant with the Hospital Transparency rule because we feel it’s the right thing to do for our patients," spokesman Thomas Lange wrote.
"We are fully compliant with the Centers for Medicare & Medicaid Services price transparency requirements," said Amanda Nageleisen, spokeswoman for UC Health.
"The report from patientrightsadvocate is inaccurate," Mercy Health's Billie Jean Mounts said. "When it comes to price transparency we are proud to have been recognized by Turquoise Health as one of the most transparent systems in the nation."
The American Hospital Association has similarly disputed the nonprofit's findings, writing in a statement that patientrightsadvocate.org's latest report "mischaracterizes hospitals’ compliance with federal price transparency regulations" and pointed to the U.S. Centers for Medicare & Medicaid Services' assessment that 70% of hospitals are complying with the federal rule.
According to documents from CMS, six hospitals have been penalized for noncompliance of the transparency rule so far:
Northside Hospital Atlanta.
Northside Hospital Cherokee (Canton, Georgia).
Frisbie Memorial Hospital (Rochester, New Hampshire).
Falls Community Hospital & Clinic (Marlin, Texas).
Fulton County Hospital (Salem, Arkansas).
Community First Medical Center (Chicago).
The fines range from $63,900 to $883,180.
"This is the law," Fisher said. "And why this is so important is because every day, patients are put into medical debt and financial ruin. Nearly every time, there's a story about being overcharged."
More than 100 million Americans have medical debt, an NPR/Kaiser Health News found.
Employers could use price comparisons to lower costs
Enforcing more compliance toward showcasing prices is the government's solution to ensuring transparency. Experts however, think real momentum could come from employers.
If employers were to engage in some basic shopping for both insurance providers and individual procedures, price transparency could really gather some momentum, Fisher argued. Some employers have already begun that process.
Ashtabula Area City Schools, in northeast Ohio, for instance, saved $2.4 million on health care spending over a 12 month period by directly contracting with price-transparent providers and facilities, cutting out middle players and launching an on-site primary care facility.
"This is the beginning of a revolution in American health care to lower costs and protect patients," Fisher said. "It's up to all of us to be our own advocates.
Jewell was aware of the convoluted health industry when he attempted to shop around insurance plans for his employees. What surprised him was how quickly costs can change, how fast an estimate balloons in price and the inconsistency at how much it costs to cover a family with in insurance.
"What you're counting on is that your insurance company has negotiated great rates with the hospitals," Jewell said. "That's what health care is totally based on."
Aside from employers, researchers and policy makers could become vital resources to ensuring transparent, competitive pricing in health care, said Lovisa Gustafsson, vice president of controlling health care costs for the Commonwealth Fund, a health care think tank based in New York.
"Patients haven't been the best users of this information that we have, historically," she said. "Because it's really complicated to access. There are other actors who could use this information to be really helpful. Employers being one. Maybe you exclude a hospital that's ridiculously expensive, unless they're trying to bring their prices down."
This article originally appeared on Cincinnati Enquirer: Hospital price transparency law still isn't working as envisioned
