Medical Transparency: New Mandate Facing Hospitals
PITTSBURGH (KDKA) – It’s called healthcare transparency.
Patient rights advocated Cynthia Fisher wants Pittsburghers to know about a new federal rule designed to end hospital “sticker shock.”
“When all the hospitals in the Pittsburgh area and outside of Pittsburgh show these prices, consumers will win. Consumers will benefit,” said Fisher.
KDKA Investigator Meghan Schiller set out to discover what local hospitals are doing to comply with both the letter and spirit of the new rule.
“We started our price transparency journey early in the [year] 2010 to 2013 time frame,” said Richard Chesnos, Sr. Vice President and CFO, St. Clair Hospital.
Nurses keep busy at St. Clair, caring and charting for 11 thousand surgery patients each year.
KDKA’s Meghan Schiller asked Chesnos: “Do you think the average person has any idea what a hip replacement, knee replacement, or scope costs?”
“I don’t believe so,” said Chesnos.
That’s why St. Clair wanted to bring transparency to hospital prices, starting in the early 2000s.
“We moved to online price transparency in 2016,” said Chesnos.
Chesnos said St. Clair’s “patient estimates tool” went live years ahead of the curve.
Effective Jan. 1, the Trump administration’s federal rule went into effect, requiring all hospitals to post prices online.
“That will make them compete on quality and price and just like every other business in our economy, hospitals and insurance companies are going to have to compete for our hard-earned healthcare dollars,” said Cynthia Fisher, founder of PatientRightsAdvocate.org.
Fisher pushed to give power back to patients.
“You wouldn’t buy a car without knowing the price, you wouldn’t go to the grocery store and buy a gallon of milk and expect to get a bill many months later,” said Fisher. “I mean, these are the games that the healthcare system has played because the consumers didn’t have the power to know.”
Hospitals must now post a downloadable list of standard charges for at least 300 services. Things like x-rays, biopsies, vasectomies, hip and knee replacements. It ends up looking like a large Excel spreadsheet.
“That looks complicated,” said KDKA’s Meghan Schiller. “It looks a little daunting,” added Chesnos.
That’s exactly why St. Clair took the sea of insurance contract data and turned it into a user-friendly tool.
“We have a category for medical imaging, cardiac, physical therapy,” said Chesnos.
All you have to do is put in your insurance details or select the no-insurance, out-of-pocket option.
“That’s how quick it is,” said Chesnos.
We searched for regular childbirth with no insurance. The tool quickly popped up an estimated number for $3,459.60 if a patient walked in that night to have a baby with no insurance.
The downloadable spreadsheet would comply with the law, as is, but Chesnos said St. Clair wanted to take a step further.
“It’s rather daunting to the consumers, that’s why we like to look at our patients’ estimates tool as one that is really complying with the spirit of the law and the spirit of what the consumer wants.”
Chesnos added the estimate takes into account a patient’s insurance, deductible, and co-insurance rates. The patient will then receive a “reference number” and can call the hospital for even more detailed information. If the patient schedules the procedure, the patient can expect to not see many variations from the estimate, considering the tool reaches out to the patient’s insurance company “in real-time.”
St. Clair is an independent hospital, but what about Pittsburgh’s 2 healthcare giants: UPMC and AHN?
KDKA’s Meghan Schiller searched Allegheny Health Network’s website first. AHN uses an online “hospital price index.” She found it to be user-friendly and she could download the price lists, meaning AHN complies with the federal rule. She could also search prices online by AHN hospital, even selecting different insurance options and procedures from a drop-down list.
We tried it out by looking up the “gross cost” of a “hip joint replacement.” The gross cost is not what a patient will end up paying, but a point for comparison.
We found gross costs ranging from $32 thousand at Allegheny Valley to $42 thousand at Jefferson in the South Hills to $52 thousand at Allegheny General Hospital on the North Side. That’s a span of $20 thousand within the same hospital system. AHN’s website points out that prices vary because of hospital location and physician availability.
Some disclaimers to keep in mind as patients maneuver these estimator tools:
- Gross cost is not what the patient will end up paying
- Total charges generally do not determine what hospitals are paid for the procedures
But, these exercises do show that insurance contracts can fluctuate between hospitals located just miles apart.
Next KDKA’s Meghan Schiller searched UPMC’s website for the word “charges.” The price lists by hospital popped up, meaning UPMC also complies with the new federal rule.
We downloaded UPMC Passavant’s price list and couldn’t easily find a price for a “hip joint replacement.” In fact, it’s hard to decipher the majority of the “procedure descriptions” on any of the hospital’s downloadable lists. We also couldn’t find a way to easily compare prices online across different UPMC hospitals, without downloading each individual hospital’s price lists.
UPMC tells KDKA’s Meghan Schiller it recommends patients call its “price estimator hotline” at 1-800-371-8359 and provide patient-specific insurance information. UPMC said more than 10 thousand patients already call that line each year.
When it comes to the new federal rule, patient advocates like Fisher believe it will help patients “shop around.”
KDKA’s Meghan Schiller asked Fisher “Why were we having procedures at hospitals and not knowing the price?”
“Patients have had absolute fear of financial ruin,” said Fisher.
She added, “Over 64 percent of Americans have delayed care because of unknown costs.”
But the hope is the sticker shock ends now since Fisher said people can use these tools to no longer feel blindsided by a medical bill.
“This is game-changing to the American consumers of healthcare because for the first time we now as consumers and patients have the right to know prices before we go to know the accurate and real prices of our healthcare and to be able to shop,” said Fisher.