News: Healthcare price transparency off to a slow start in 2019

CDI Strategies - Volume 13, Issue 2

As part of the fiscal year 2019 inpatient prospective payment system (IPPS) final rule, CMS required hospitals to publish their lists of retail charges for individual services and DRGs in online spreadsheets starting on January 1. Fulfilling that requirement, is another matter entirely, according to Modern Healthcare.

Some hospitals have struggled to post their chargemaster lists at all, others have posted lists that cause more confusion for patients than clarity, according to HealthLeaders Media. The available lists require patients to locate and piece together the price of each component of their visit or potential visit, including items such as specific blood tests, medicines, and facility and physician charges.

“I don't think it’s very helpful,” said Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management. “There are about 30,000 different items on a chargemaster file. As a patient, you don't know which ones you will use.”

Plus, lists that are available are often hidden deep in hospitals’ websites, Modern Healthcare reported. HealthLeaders Media suggests that it’s easier and faster to just Google the hospital’s name along with “billing” or “chargemaster” and find a direct link, rather than poking around your hospitals website for hours.

Even if patients find the list and try to piece together an estimate for their care costs, the names of diagnoses, procedures, treatments, etc. are often opaque to those without a medical degree. For example, the University of California San Francisco Medical Center's chargemaster includes a $378 charge for "Arthrocentesis Aspir&/Inj Small Jt/Bursa w/o Us," which is basically draining fluid from the knee.

Even when the DRG prices are listed, there may be varying charges based on the patient’s comorbid conditions—a reality CDI professionals are well aware of. While a medical professional may understand the thousands of dollars’ difference between two DRGs, that disparity may be confusing to patients, according to HealthLeaders Media.

On top of the confusing nature of chargemaster lists, the prices listed are rarely the ones that hospitals actually receive from insurers.

“From a practical standpoint, I’m not sure how useful this information is,” said Jan Emerson-Shea, vice president of external affairs for the California Hospital Association. “What an individual pays to [the] hospital is going to be based on what the insurer covers.”

Many facilities push back against the idea of publishing the average prices they generally accept from insurers, however, saying that negotiated rates are a trade secret, according to HealthLeaders Media.

Despite these many pitfalls, some experts still say that making the charges public shines a light on the often highly varying prices set by different facilities. And, posting the chargemaster lists represents a first step at price transparency for patients.

Editor’s note: To read ModernHealthcare’s coverage of this story, click here. To read HealthLeaders Media’s coverage of this story, click here. To read more about the IPPS final rule and what it entailed, click here.

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