LAKELAND – An advocacy group says Polk County hospitals fall short of providing all the pricing information patients need to shop around for services and avoid receiving an unexpectedly high medical bill.

A federal law says hospitals must post the prices for medical procedures. The goal is to help patients make more informed decisions, increase competition in the health care industry and drive down the cost of health care.

While Polk hospitals showed some progress toward pricing transparency, their efforts fell short of the goals set out in the law, according to a study released in February by the PatientRightsAdvocate.org.

Hospitals are required to post online a 'machine-readable file' of charges

The rule issued by the Centers for Medicare and Medicaid Services requires hospitals to post online a “machine-readable file” of charges for the services it offers.

The entries must also include the different rates it charges insurers and a consumer-friendly list of charges for the hospital’s 300 most “shoppable services,” which are considered services that can be scheduled in advance.

Cynthia A. Fisher, who founded the advocacy organization, said in Florida the negotiated rates – pricing set between insurers and hospitals – are not being fully disclosed or at all in order to be in compliance with the law, which was originally enacted in the Affordable Care Act and has gained bipartisan support.

The new hospital price transparency rule took effect Jan. 1, 2021, requiring hospitals to post all prices online, easily accessible without barriers such as having to submit personal identifying information.

“Only in health care have patients been blind to not know prices in advance of their care,” she said in a phone interview. “The same applies for purchasers of all health plans.”

About 175 million Americans are covered primarily under employer sponsored health care plans, another 20 million on the exchange and 10 million without insurance and the remaining people have Medicaid or Medicare, Fisher said.

“If you think about it, we have not been able to see either pricing from the insurance companies nor from the hospitals and they have made their deals in a back room behind closed doors and essentially keeping employers and patients in the dark allowing them to charge whatever they want,” Fisher said.

According to the advocacy group’s study, none of Polk County’s hospitals they examined made their list for disclosing to patients the actual cost of care at their facilities as the law specifies. Just 14% of hospitals nationwide are complying with the price transparency rule, the report said.

While some progress to full compliance has been made by Polk’s hospitals, the pricing they list still has not cleared every barrier the law seeks to remove for patients buying hospital services.

The advocacy group sends out semi-annual reports, and its latest in February shows the following Polk County hospitals as non-compliant:

• Lakeland Regional Health Medical Center.

• Winter Haven Hospital – BayCare

• AdventHealth Heart of Florida.

• Bartow Regional Medical Center – BayCare.

Lance Green, executive vice president and chief financial officer at LRH, said said in an email, “Lakeland Regional Health recently received correspondence from the Centers for Medicare and Medicaid Services indicating that we are compliant with all Hospital Price Transparency regulatory requirements.

“We are committed to providing price transparency for our patients and families and offer a Price Transparency page on our website where people can find more information,” he said.

A link he provided opens a spreadsheet of prices for more than 7,600 services and medical supplies for which a patient can be charged.

According to the patient advocacy group study, only 37.9% of the hospitals nationwide posted a sufficient amount of negotiated rates, but over half were not compliant in other criteria, such as rates by each insurer and named plans.

At LRH, many of the various negotiated prices columns in its spreadsheet were broken down by health insurer, but due to the volume of the data and industry jargon it was difficult to immediately locate pricing for every procedure for all the insurers listed on the spreadsheet. None of the hospitals contacted for this report provided a separate list of 300 shoppable services.

Lakeland's homeless: Lakeland considers changing city codes to better police homeless

Ivermectin and COVID: Lakeland Regional joins national study to see if ivermectin is effective against COVID-19

Unnecessary?: Study: Lakeland Regional Health listed among top 20 U.S. hospitals providing 'unnecessary care'

The experience was similar at AdventHealth and BayCare Health System’s website, which both host a price estimator, which asked for personal information such as a patient's health insurance information and email address in an online form.

“All BayCare affected facilities are listed in the pricing estimator located on BayCare’s website, and the services available for self-estimate include the 300 shoppables for each facility,” said Lisa Razler, public relations manager at BayCare.

“These estimates can be run as a self-pay estimate, or the estimate can be customized to each person’s individual insurance information as appropriate,” she said.

“In addition, information continues to be updated regarding the standard charges and negotiated rates for each hospital,” Razler said.

“This updated format and information has been posted for Bartow Regional Medical, Winter Haven Hospital, South Florida Baptist, and Morton Plant hospitals. As this is a very labor-intensive process, BayCare continues to work on additional data publication for the remaining facilities,” she said.

AdventHealth provided a similar statement via email.

“AdventHealth is committed to price transparency and providing information to consumers that will help them make informed decisions before receiving elective services,” said Amber Smith, a spokeswoman for AdventHealth Heartland Region.

“For the AdventHealth hospitals in Polk County, we have published a machine-readable file online containing payer-negotiated rates for all payers and plans and provided a price estimator tool for consumers to calculate their out-of-pocket costs for shoppable services, as required by the CMS price transparency Rules,” she said.

Not all hospitals in Florida were non-compliant in the report

Not all hospitals in Florida were non-compliant in the PatientRightsAdvocate.org report, the following hospitals were in compliance with the rule in Florida based on the group's report:

• AdventHealth Tampa.

• Cleveland Clinic Florida.

• Johns Hopkins All Children’s Hospital.

• Lakewood Ranch Medical Center.

• Mayo Clinic Hospital in Florida.

• North Okaloosa Medical Center.

• Sacred Heart Hospital on the Emerald Coast.

A Forbes Magazine article said, only 9% of U.S. adults know about the rule and more than twice as many, 22%, think hospitals are not required to post the prices of treatments and procedures, citing a report by the Peterson Center on Health Care and the Kaiser Family Foundation.

The advocacy group is not the only organization critical of the hospital pricing shortfalls. Research published in JAMA Internal Medicine in June 2021, found that among 100 randomly chosen hospitals, 83% fail to comply with at least one of the rule’s requirements, Forbes reported.

About half the hospitals offer the required consumer-friendly cost estimator; only 33% provide payer-specific negotiated rates.

An inquiry with CMS about Polk County hospitals' compliance and any potential enforcement actions was not immediately available.

An email statement from CMS said, as of early February 2022, CMS had issued approximately 342 warning notices to hospitals as well as 124 "corrective action plan requests" for hospitals that were warned but hadn't corrected problems.

"Specifics surrounding the compliance and status of hospitals is not publicly available," CMS said. The agency said that rule dictates that once a hospital is hit with a monetary penalty, its name becomes public.

"Releasing this information prematurely could identify hospitals that have already taken corrective actions and come into compliance after issuance of a warning notice," CMS said.

So far, it said, every hospital that has come under compliance review has resolved its problems or is in the process of doing so. "Therefore, it has not been necessary for CMS to issue any penalties."

In a statement to television station WREG in Memphis, the CMS acknowledged problems with hospital pricing website tools and said it's stepping up enforcement of the new policy by increasing fines to reach a potential $2 million a year for hospitals.

The agency’s ultimate penalty is imposing a fine of up to $300 a day, the station reported. When the rule was first proposed, many hospitals objected to disclosing their negotiated rates with different payers, saying the requirement would destroy their negotiating power.

This article originally appeared on The Ledger: Polk hospitals among those lacking price transparency, nonprofit lists