Most Colorado hospitals at least partially comply with rules designed to make it easier for patients to buy care, but even if people find and use all the pricing tools available, there’s always a chance they won’t. not know what they are paying before they get an invoice.
Colorado passed a law requiring hospitals to post self-paid prices for their most common procedures in 2017. Two years later, the Centers for Medicare and Medicaid Services required hospitals to post their billing managers – essentially , a list of “sticker prices” for almost everything they offer, from steps to the daily rate of a room.
Now, hospitals must also display the rates they have negotiated with insurance companies and the discounts they offer to uninsured people, as well as the estimated cost of “purchasable” services.
The Denver Post polled the websites of 87 Colorado hospitals to see if they published pricing information, as required by the state and the federal Centers for Medicare and Medicaid Services. Of these, 34 hospitals posted all required prices, 34 posted only the sticker price, two posted no price, and the rest posted a subset of the required information.
This is better than the rate that some national studies have found. The nonprofit group Patient Rights Advocate randomly sampled 500 of the country’s roughly 6,000 hospitals that are subject to the rule, and found only 28 included complete information. The most common problem was to omit at least some prices, such as the rates negotiated with insurance plans or the spot price charged to uninsured patients.
It is possible that the difference stems from the group of hospitals examined, and not from an inherent tendency to follow Colorado rules. Nationwide studies have focused on large medical centers and hospital systems, but The Post’s analysis included both small and large hospitals. The majority of all-price hospitals in Colorado were independent, and many were small rural facilities.
Julie Lonborg, senior vice president of the Colorado Hospital Association, said it was difficult to quickly release all of this information, especially as hospitals have diverted much of their technological talent to handling COVID-19 reports. required. There are also lingering questions about what counts as sufficiently “user-friendly” language and whether the release of information required for federal mandates will satisfy state law, she said.
“I think we need to give everyone time after COVID to catch up,” she said. “If we hadn’t done this on top of a global pandemic, we might be a little further away. “
Lincoln Health, which includes a 15-bed hospital in Hugo, was one of 34 hospitals that posted all required prices. Spokeswoman Megan Mosher said they contracted with a company that sells transparency tools to ensure they are in compliance, but the expense and time to maintain them could be better spent elsewhere. Few patients use the tools, and they can get more relevant information by calling, she said.
“Our patient financial advisor is able to provide full, accurate and comprehensive price estimates to our patients, resulting in better education and financial preparedness for our patients, which is really the reason for be transparency, ”she said.
Hospitals that do not comply with federal requirements can be fined up to $ 300 per day, but the Federal Centers for Medicare and Medicaid Services have proposed increasing this amount to $ 5,500 per day for larger hospitals. . Small hospitals would pay $ 10 per bed each day if they didn’t comply.
Make the prices public
Supporters of transparency argue that forcing hospitals to display their prices will lower health care spending by allowing people to shop. Professional hospital groups counter that the information is essentially useless to the average person. Awareness of transparency rules is low: A May poll by the Kaiser Family Foundation found that only about 9% of people knew hospitals were required to post prices.
Making pricing data public is helpful in shaping policy and holding high-cost hospitals accountable, said Adam Fox, deputy director of the Colorado Consumer Health Initiative. It can also help patients who are trying to find affordable care, but the prices listed are not a guarantee, he said.
“Ultimately, this increased transparency is good, but it’s not a silver bullet to lower healthcare costs,” he said.
The vast majority of Colorado hospitals have complied with the requirement to post charges. Two of the 87 hospitals – Heart of the Rockies Medical Center and Telluride Regional Medical Center – do not appear to have published one, although Heart of the Rockies did have a tool for patients to view prices. Sedgwick County Health Center released a file, but it did not contain any information when uploading, suggesting a technical issue.
The requirement that hospitals publish their leaders was a “useful first step,” but it only allows for general comparisons between hospitals that are more or less expensive, Fox said. Base prices are largely moot, as private insurers pay lower rates and most hospitals offer discounts to people who pay out of pocket.
In 2019, federal regulators announced that they would also require hospitals to list what they charge to the various insurance plans they accept, and the prices they charge to people who pay out of pocket. They also needed a list of 300 “buyable” services – planned procedures that allow for price comparisons.
The American Hospital Association sued to block the new rules and lost. In April, the US Department of Health and Human Services began sending warning letters to hospitals that had not released all the required information, but two studies in June found that a significant amount of data contained still incomplete data on their websites. Federal regulators have delayed issuing fines to give hospitals more time to adjust, but it’s unclear how long this reprieve will last.
Only three Colorado hospitals have not released any services that can be purchased: Telluride Regional Medical Center, Keefe Memorial Hospital and Sedgwick County Health Center, which once again released a file that showed no given. Grand Junction Community Hospital has not released a separate file of services that can be purchased, but has added all the required information to its charge manager.
However, some hospitals have made it easier to find merchant services than others. On 17 hospital websites, someone looking for the list of purchasable services had to click through five screens, sometimes starting on pages that weren’t intuitive, like the “pay my bill” section. Hospitals that had a price estimation tool often required anyone to navigate between personal information before using it, which could discourage some people from shopping.
Good to recheck
The new requirements give people a better idea of what they might actually be paying than the charge manager, although it may still be a good idea to check with the hospital and your insurance company, said Fox. What you actually pay will depend on the complexity of your care, whether all of your doctors are in your insurance company’s network, and how much of the total cost your insurance plan forces you to pay out of pocket.
“These shouldn’t be taken as the amount someone will be charged,” he said.
Colorado Department of Health policy and funding called for changes to make the prices easier to use and to increase penalties for hospitals that do not comply. In a letter to the Centers for Medicare and Medicaid Services, he asked federal regulators to:
- Require hospitals to give guaranteed prices, not just estimates
- Increase the minimum penalty to $ 300 per day, without maximum penalty
- Order hospitals with pricing tools to allow patients to use them without entering personal information
- Require standardized tools and formats, so patients can make comparisons more easily
Colorado hospitals support price transparency, Lonborg said, but the association does not believe that the release of more information will benefit patients. The best strategy is for patients to call their insurance company and then the hospital they are considering, she said.
“It is in everyone’s best interest that patients know A) what their responsibility is and B) what their other options are,” she said. “These laws and requirements were well-intentioned, I’m sure, but even (the Centers for Medicare and Medicaid Services) have admitted they’re not that helpful.”
Ultimately, there is no real way for patients to know what they might be paying up front, Fox said.
Even if patients look up prices, check with their insurance companies, and get estimates from a hospital’s billing department, there’s still a chance they’ll pay more if a doctor is out of the network or if they end up. need more complex care than anticipated. Still, it may be worth having an estimate on hand, in case you need to push back an excessive bill, he said.
“We’ve had cases where people have called ahead… and they’re quoted one thing, and when the bill comes in it’s something quite different,” he said. “It’s really hard to get a good estimate.