Feds make hospitals reveal costs


Staff Writer

Monday, January 7, 2019

The new year ushered in a new era of price transparency for hospitals, if patients know where to look, how to interpret obscure data and are aware that hospital charges bear little resemblance to the bill they actually receive.

“A Centers for Medicare and Medicaid Services rule enacted in April 2018 requires every U.S. hospital to publish its standard price list online, effective Jan. 1, 2019,” said L. Lee Isley, president and CEO of Nash UNC Health Care.

According to a statement issued in August by the Centers for Medicare and Medicaid Services, the rule was designed to empower patients and advance the White House MyHealthEData initiative and the CMS Patients Over Paperwork initiative.

“While CMS previously required hospitals to make publicly available a list of their standard charges or their policies for allowing the public to view this list upon request, CMS has updated its guidelines to specifically require hospitals to post this information on the Internet in a machine-readable format,” the statement said.

Local hospitals’ information is not very accessible or patient-friendly at present. Nash UNC Heath Care prices, for instances, are not available directly on the hospital’s website. When located on the site, prices only are available in an Excel format that is very difficult to read because of the way it is presented.

Nash and all other UNC hospitals have posted their hospital-based procedures, services, supplies, prescriptions drugs, diagnostic tests and associated fees at https://www.unchealthcare.org/about-us/billing-and-financial-assistance/chargemaster

“The chargemaster lists more than 9,000 items at Nash UNC, their common procedure codes and the charge per unit,” Isley said.

An examination of the NASH UNC Heath Care link reveals that though costs for specific items such as pharmacy items and screws are listed, common services patients may want to compare, such as an MRI, are not assigned a charge.

Charges for Vidant Edgecombe Hospital services are more complete and user-friendly though still difficult to find without scrolling through a list of thousands of charges. Consumers still must go to the main Vidant site to find the list for charges at Vidant Edgecombe. But the charges are available in three different formats and are much easier to read. These charges can be found at https://www.vidanthealth.com/Patients-Families/Billing/PricingTransparency .

Even if consumers manage to locate the lists, it still gives them no notion of the final cost unless they also have a list of all the items and services they will need during their procedure or hospital visit.

As the Vidant website explains, “The total charge for a hospital service is made up of many factors related to direct patient care as well as staffing, equipment and maintenance. Each patient’s course of treatment is unique, and the cost of medications, supplies, tests and other services required for a particular procedure will be impacted by differences in treatment orders, length of stay, potential complications and other health conditions. Additionally, you may have charges by other professionals outside the hospital who are involved in your care such as specialty physicians, radiologists and anesthesiologists.”

The charges are also only relevant to patients that pay the bill themselves without insurance, which accounts for 9 percent  to 12 percent of patients at Nash UNC Health Care, said Dorsey Tobias, director of marketing and communications at Nash UNC Health Care. 

And even those patients can ask for discounts on the charges that will bring them more in line with what insurance companies pay, Tobias said.

For most patients, the prices they pay will be far different because of negotiated rates with insurance providers, which vary widely.

“The unit charge listed is unlikely to be the amount that a patient sees on a bill because of the wide variety of prices negotiated with various insurance plans,” Isley said. ”For patients with Medicare and Medicaid, the government sets fee schedules with the allowable charges for Medicare approved services, and therefore there is no association between what Medicare recognizes as an allowable charge and what charges are listed on our website.”

Health care is one of the few areas left where consumers are expected to agree to pay for services without having any idea of the cost or having the option to compare those costs across the marketplace. While new regulations seek to begin to change that, the vagaries of the health care system can make the information difficult to obtain.

“At Nash UNC Health Care, we recognize that paying for health care can be very overwhelming to patients, especially given the complexities of insurance and payor structures. We support efforts to improve price transparency for our patients, but because of the variations in health insurance coverage, it is difficult to provide specific costs that will be applicable to all patients,” Isley said.

Isley said new tools at Nash UNC Health Care should help make estimating costs clearer.

“Our new electronic medical record Epic@UNC allows our customer service representatives to access a pricing estimator tool that can provide an estimate of the cost of service for a patient based on aggregate data provided by the patient’s insurance or payor. Many insurance carriers also offer pricing estimator tools,” Isley said.

However, Isley said patients need to understand their insurance coverage and know their deductibles, co-payments, co-insurance and out-of-pocket maximums.

“It’s important for patients to work with their care provider and insurance provider to discuss their specific situation. Nash UNC Health Care has customer service representatives and financial counselors available to help patients decipher their coverage, understand their bills, request financial assistance and more. We encourage patients to reach out and asked detailed financial questions, especially in advance of scheduled services,” Isley said.